Healthcare Provider Details

I. General information

NPI: 1902028939
Provider Name (Legal Business Name): FRANK JAVIER TANON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W BELVEDERE AVE SUITE 104
BALTIMORE MD
21215-5228
US

IV. Provider business mailing address

2401 W BELVEDERE AVE CREDENTIALING DEPT.
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-8691
  • Fax: 410-601-8996
Mailing address:
  • Phone: 410-601-5524
  • Fax: 410-601-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberD0065957
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD0065957
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD0065957
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: