MEDICARE: BETHANY BRAGDON 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	208600000X	Surgery Physician	MD34085	DC
2	208600000X	Surgery Physician	0101056108	VA
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD34085	DC
4	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	0101056108	VA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427023217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY BRAGDON TAN MD

Provider Business Mailing Address
First Line	:	6251 E VIRGINIA BEACH BLVD STE 300
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2800
Country	:	US
Telephone Number	:	757-261-5000
Fax Number	:	757-962-5610

Provider Business Practice Location Address
First Line	:	6251 E VIRGINIA BEACH BLVD STE 300
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2800
Country	:	US
Telephone Number	:	757-261-5000
Fax Number	:	757-962-5610

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/13/2024

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Directions to “ BETHANY BRAGDON TAN MD” Practice Location

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