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NPI Code Detail

MEDICARE: DR. MARY ALDRENE TAN M.D.

MEDICARE: DR. MARY ALDRENE TAN M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician238301-1NY
2207ZD0900XDermatopathology (Pathology) Physician238301-1NY

General Provider Information

NPI Number : 1255510194
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY ALDRENE TAN M.D.
Provider Business Mailing Address
First Line : PO BOX 840294
Second Line :
City : DALLAS
State : TX
Zip : 75284-0294
Country : US
Telephone Number : 888-344-1160
Fax Number : 972-331-3148
Provider Business Practice Location Address
First Line : 15 CRAWFORD ST STE 100
Second Line :
City : NEEDHAM
State : MA
Zip : 02494-2618
Country : US
Telephone Number : 617-969-4100
Fax Number : 617-969-3393
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2007
Last Update Date : 03/21/2018

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