Healthcare Provider Details

I. General information

NPI: 1316059603
Provider Name (Legal Business Name): TATIANA V SANSES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW FACULTY PRACTICE PLAN TOWER 1700
WASHINGTON DC
20060-1734
US

IV. Provider business mailing address

2041 GEORGIA AVE NW FACULTY PRACTICE PLAN SUITE 6101
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-4164
  • Fax: 202-865-7407
Mailing address:
  • Phone: 202-865-6679
  • Fax: 202-865-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD045673
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35-094680
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD64589
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberD64589
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD45673
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: