MEDICARE: DR. SHIRLEY ELBINIAS-TAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	200201575	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083606685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLEY ELBINIAS-TAN MD

Provider Business Mailing Address
First Line	:	PO BOX 40908
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28309-0908
Country	:	US
Telephone Number	:	910-615-6448
Fax Number	:	910-615-5070

Provider Business Practice Location Address
First Line	:	4092 PROFESSIONAL DR
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-2366
Country	:	US
Telephone Number	:	910-615-3120
Fax Number	:	910-423-6050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/20/2012

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