Provider Demographics
NPI:1538715057
Name:O'BRIEN, TIA GIALUONG (PA-C)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:GIALUONG
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:GIALUONG
Other - Last Name:LA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 COLLEGE AVE # DIF123
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5778
Mailing Address - Country:US
Mailing Address - Phone:570-327-4779
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE AVE # DIF123
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5778
Practice Address - Country:US
Practice Address - Phone:570-327-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU363A00000X
OH50.008686RX363A00000X
NY031788-01363A00000X
PAMA063818363AM0700X
PAOA006188363AM0700X
NJ25MP00831300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical