Basic Information
| Provider Information | |||||||||
| NPI: | 1144269069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALLIA | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | REGINE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2491 REVERE CT | ||||||||
| Address2: | |||||||||
| City: | CROFTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211143251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107211554 | ||||||||
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| Practice Location | |||||||||
| Address1: | 575 MAIN ST | ||||||||
| Address2: | SUITE351 | ||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207074343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014985990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | C0002443 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.