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General NPI Number Information
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NPI Number | 1962585042
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Entity Type | Individual
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Provider Name | GIAC CHAN NGUYEN TAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 171 GRANDVIEW AVE STE 105
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City | WATERBURY
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State | CT
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Zip | 06708-2519
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Country | US
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Telephone | 203-694-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 171 GRANDVIEW AVE STE 105
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City | WATERBURY
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State | CT
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Zip | 06708-2519
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Country | US
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Telephone | 203-755-2214
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Fax | 203-596-1133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | 028148
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 028148
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 028148
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License Number State | CT
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