Individual
TATYAN MILA CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3401 N BROAD ST, 4TH FL PARKINSON PAVILION, PHILADELPHIA, PA 19140-5103
(215) 707-3133
(215) 707-3945
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-3133
(215) 707-3945
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A94539
CA
208600000X
Surgery Physician
Primary
MD447082
PA
208600000X
Surgery Physician
ME109632
FL
Other
Enumeration date
11/13/2007
Last updated
03/21/2017
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