Provider Demographics
NPI:1003046624
Name:TAN, THEODORE CONRAD ANG (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE CONRAD
Middle Name:ANG
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 NEW BURTON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-5488
Mailing Address - Country:US
Mailing Address - Phone:302-730-0554
Mailing Address - Fax:302-730-1175
Practice Address - Street 1:810 NEW BURTON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-5488
Practice Address - Country:US
Practice Address - Phone:302-730-0554
Practice Address - Fax:302-730-1175
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10010131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine