Individual
ANTHONY TAVELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
111 ROUTE 715 STE 104, BRODHEADSVILLE, PA 18322-7101
(272) 212-0434
(866) 230-8056
Mailing address
111 ROUTE 715 STE 104, BRODHEADSVILLE, PA 18322-7101
(272) 212-0434
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA065717
PA
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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