Healthcare Provider Details

I. General information

NPI: 1679079693
Provider Name (Legal Business Name): XIAO-WEI CHERIE TAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 THOMAS JOHNSON DR STE 250
FREDERICK MD
21702-4972
US

IV. Provider business mailing address

112 THOMAS JOHNSON DR STE 250
FREDERICK MD
21702-4972
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-6777
  • Fax: 301-695-4852
Mailing address:
  • Phone: 301-695-6777
  • Fax: 301-695-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number326990
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0091499
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number326990
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD0091499
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: