Active NPI
Katherine Tardy
- Surgery Physician
- Wynnewood, PA
National Provider Identifier
1376170050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MT220255
- Practice address
- 100 E Lancaster Ave
Wynnewood, PA 19096-3450 - Phone
- (484) 476-2658
- NPI assigned
- Mar 24, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Surgery Physician | 208600000X | MT220255 | PA | Primary |
Addresses
Primary practice location
100 E Lancaster Ave
Wynnewood, PA 19096-3450
Mailing address
100 E. Lancaster Avenue, Mob South 422
Wynnewood, PA 19096
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT220255 | PA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733788800000",
"number": "1376170050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E. LANCASTER AVENUE, MOB SOUTH 422",
"city": "WYNNEWOOD",
"state": "PA",
"postal_code": "19096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E LANCASTER AVE",
"city": "WYNNEWOOD",
"state": "PA",
"postal_code": "190963450",
"telephone_number": "484-476-2658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TARDY",
"first_name": "KATHERINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-24",
"last_updated": "2024-12-10",
"certification_date": "2024-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MT220255",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wynnewood, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.