MEDICARE: JOSENIA NARCISA MAILED 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	241466	MA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	274796	NY

General Provider Information

NPI Number	:	1982831228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSENIA NARCISA MAILED TAN MD

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:	585-723-7765
Fax Number	:	585-273-3637

Provider Business Practice Location Address
First Line	:	1561 LONG POND RD STE 130
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4136
Country	:	US
Telephone Number	:	585-723-7765
Fax Number	:	585-273-3637

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

Provider Enumeration Date	:	06/14/2009
Last Update Date	:	10/02/2020

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