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General NPI Number Information
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NPI Number | 1992052120
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Entity Type | Individual
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Provider Name | TANA ANDRE D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER BLVD POB 1, SUITE 407
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City | CHESTER
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State | PA
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Zip | 19013-3902
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Country | US
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Telephone | 610-619-7413
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER BLVD POB 1, SUITE 407
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City | CHESTER
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State | PA
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Zip | 19013-3902
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Country | US
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Telephone |
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OS018076
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License Number State | PA
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