Healthcare Provider Details

I. General information

NPI: 1972587103
Provider Name (Legal Business Name): EMMANUEL TAN QUIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19182-0933
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2500
  • Fax: 215-728-3639
Mailing address:
  • Phone: 215-728-2500
  • Fax: 215-728-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD050469L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: