MEDICARE: DR. JESUS HO 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	173000000X	Legal Medicine	521167179	MD

General Provider Information

NPI Number	:	1396715769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS HO TAN MD

Provider Business Mailing Address
First Line	:	4 S BROADWAY
Second Line	:
City	:	FROSTBURG
State	:	MD
Zip	:	21532-1708
Country	:	US
Telephone Number	:	301-689-3138
Fax Number	:	301-689-9561

Provider Business Practice Location Address
First Line	:	4 S BROADWAY
Second Line	:
City	:	FROSTBURG
State	:	MD
Zip	:	21532-1708
Country	:	US
Telephone Number	:	301-689-3138
Fax Number	:	301-689-9561

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	01/25/2026

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