MEDICARE: DR. FRITZI ALMA TANNER 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
1	208000000X	Pediatrics Physician	MAO61584	NJ

General Provider Information

NPI Number	:	1326140013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRITZI ALMA TANNER M.D.

Provider Business Mailing Address
First Line	:	206 LAUREL HEIGHTS DR
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-3634
Country	:	US
Telephone Number	:	856-459-2270
Fax Number	:	856-459-9674

Provider Business Practice Location Address
First Line	:	206 LAUREL HEIGHTS DR
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-3634
Country	:	US
Telephone Number	:	856-459-2270
Fax Number	:	856-459-9674

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	01/23/2012

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