Individual
DR. HERBERT TISNOWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1837 S 65TH ST, PHILADELPHIA, PA 19142-1423
(215) 726-0181
(215) 726-5110
Mailing address
1837 S 65TH ST, PHILADELPHIA, PA 19142-1423
(215) 726-0181
(215) 726-5110
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD028686E
PA
208D00000X
General Practice Physician
Primary
MD028686E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009887700002
—
PA
01
—
0035661000
PERSONAL CHOICE PPO OF PENNSYLVANIA (INDEPENDENT BLC)
PA
01
—
0035661001
PENNSYLVANIA KEYSTONE HEALTH PLAN EAST
PA
01
—
080019943
RAILROAD MEDICARE
PA
01
—
1831195619
KEYSTONE FIRST
PA
01
—
232626909
TRICARE PALMETTO (REGIONS 1-6)
PA
Enumeration date
06/25/2005
Last updated
09/09/2022
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