Provider Demographics
NPI:1447544697
Name:BAMAT, TARA WEDIN (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:WEDIN
Last Name:BAMAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:DANIELLE
Other - Last Name:WEDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3401 CIVIC CENTER BLVD STE 9NW
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:215-590-1000
Mailing Address - Fax:
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDRENS HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-2164
Practice Address - Fax:215-590-2180
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451398208000000X, 2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD451398Medicaid