Individual
TANYA D ANTOSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 LANCASTER AVE, WYNNEWOOD, PA 19096-3450
(484) 476-2000
Mailing address
100 LANCASTER AVE, WYNNEWOOD, PA 19096-3450
(484) 476-2000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
25MP00279900
NJ
363AM0700X
Medical Physician Assistant
MA053181
PA
363AS0400X
Surgical Physician Assistant
Primary
MA05311
PA
Other
Enumeration date
09/06/2007
Last updated
12/07/2017
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