Individual
GERALD TADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
335 E WYOMING AVE, PHILADELPHIA, PA 19120
(215) 455-0113
(215) 455-0853
Mailing address
101 E OLNEY AVE, 400, PHILADELPHIA, PA 19120-2421
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS006204L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011284400005
—
PA
Enumeration date
02/02/2006
Last updated
07/13/2018
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