Healthcare Provider Details

I. General information

NPI: 1972644813
Provider Name (Legal Business Name): SIGMUND BERNARDINO TAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11848 ROCK LANDING DR #303
NEWPORT NEWS VA
23606-4425
US

IV. Provider business mailing address

11848 ROCK LANDING DR #303
NEWPORT NEWS VA
23606-4425
US

V. Phone/Fax

Practice location:
  • Phone: 757-591-2260
  • Fax: 757-595-2001
Mailing address:
  • Phone: 757-591-2260
  • Fax: 757-595-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0102202036
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: