MEDICARE: TIFFANY JUNE-TIEN PAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	0101269568	VA

General Provider Information

NPI Number	:	1336434570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY JUNE-TIEN PAN MD

Provider Business Mailing Address
First Line	:	PO BOX 715868
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19171-5868
Country	:	US
Telephone Number	:	804-915-1910
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 BALLENGER AVENUE
Second Line	:	SUITE 200
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-6818
Country	:	US
Telephone Number	:	703-810-5209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	09/26/2022

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