Healthcare Provider Details

I. General information

NPI: 1508961319
Provider Name (Legal Business Name): CARL TAHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 LONGWOOD AVE
ROCKLEDGE FL
32955
US

IV. Provider business mailing address

908 W 4TH NORTH ST
MORRISTOWN TN
37814-3894
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-2111
  • Fax: 321-636-7180
Mailing address:
  • Phone: 423-492-6100
  • Fax: 423-492-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberM-2288
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2018033152
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number89137
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101281530
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2018033152
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0447691
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: