MEDICARE: MARIE KWAI-CHE TAN 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	MD-041730-L	PA

General Provider Information

NPI Number	:	1679521496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE KWAI-CHE TAN M.D.

Provider Business Mailing Address
First Line	:	3344 ROUTE 130,
Second Line	:	SUITE A, PO BOX 415,
City	:	HARRISON CITY
State	:	PA
Zip	:	15636-0415
Country	:	US
Telephone Number	:	724-744-3660
Fax Number	:	724-744-3815

Provider Business Practice Location Address
First Line	:	3344 ROUTE 130
Second Line	:	SUITE A,
City	:	HARRISON CITY
State	:	PA
Zip	:	15636-1238
Country	:	US
Telephone Number	:	724-744-3660
Fax Number	:	724-744-3815

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	01/02/2008

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