MEDICARE: I.A. TANGOREN, M.D., P.L.L.C.

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	207N00000X	Dermatology Physician	209386-1	NY

General Provider Information

NPI Number	:	1265594584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I.A. TANGOREN, M.D., P.L.L.C.

Provider Business Mailing Address
First Line	:	2949 ERIE BLVD E STE 110
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13224-1460
Country	:	US
Telephone Number	:	315-424-1430
Fax Number	:	315-424-1779

Provider Business Practice Location Address
First Line	:	2949 ERIE BLVD E STE 110
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13224-1460
Country	:	US
Telephone Number	:	315-424-1430
Fax Number	:	315-424-1779

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	DR. TRACY E. BARRETT-TANGOREN
Credential	:	M.D.
Telephone Number	:	315-569-7900

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	09/24/2013

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