MEDICARE: CORINA DUPREE TENNANT 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	207V00000X	Obstetrics & Gynecology Physician	MD448545	PA
2	207V00000X	Obstetrics & Gynecology Physician	C1-0012493	DE

General Provider Information

NPI Number	:	1588898027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINA DUPREE TENNANT MD

Provider Business Mailing Address
First Line	:	4755 OGLETOWN STANTON RD STE 1900
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19718-2200
Country	:	US
Telephone Number	:	302-733-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 BELMONT AVE STE 1
Second Line	:
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-3498
Country	:	US
Telephone Number	:	802-257-0341
Fax Number	:	802-257-8834

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

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	03/04/2021

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