Basic Information
| Provider Information | |||||||||
| NPI: | 1669415683 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PECHET | ||||||||
| FirstName: | TAINE | ||||||||
| MiddleName: | TAYARD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PECHET | ||||||||
| OtherFirstName: | TAINE | ||||||||
| OtherMiddleName: | TAYARD VALERE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3400 CIVIC CENTER BLVD FL 1 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191045161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156155864 | ||||||||
| FaxNumber: | 2153498432 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 CIVIC CENTER BLVD FL 1 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191045161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156155864 | ||||||||
| FaxNumber: | 2153498432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA07305200 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | 25MA07305200 | NJ | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | MD073603L | PA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | PE1307068 | 01 | PA | BLUE SHIELD | OTHER |