Basic Information
| Provider Information | |||||||||
| NPI: | 1639469950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIWARY | ||||||||
| FirstName: | TARKESHWAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 NORLAND AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172641600 | ||||||||
| FaxNumber: | 7172646319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD448765 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | MD448765 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 102828160 0001 | 05 | PA | MEDICAID | 8807457 | 01 | PA | AETNA HMO | OTHER | P01192077 | 01 | PA | RAILROAD MEDICARE | OTHER | 002886854 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 4861383 | 01 | PA | AETNA NON HMO | OTHER |