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General NPI Number Information
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NPI Number | 1992961148
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Entity Type | Organization
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Legal Business Name | PAT TANA, M.D., PA
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 5400 OLD COURT RD SUITE 101
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5100
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Country | US
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Telephone | 410-922-1661
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Fax | 410-922-0365
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Provider Business Mailing Address
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Address Line | 5400 OLD COURT RD SUITE 101
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5100
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Country | US
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Telephone | 410-922-1661
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Fax | 410-922-0365
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Authorized Official
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Title or Position | OWNER
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Name | PAT TANA
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Credential | M.D., PA
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Telephone | 410-922-1661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D21797
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License Number State | MD
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