Provider Demographics
NPI:1043256035
Name:TANNER, CAROLINE M (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:M
Last Name:TANNER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 ALMANOR AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-2934
Mailing Address - Country:US
Mailing Address - Phone:408-734-2800
Mailing Address - Fax:408-734-8455
Practice Address - Street 1:675 ALMANOR AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-2934
Practice Address - Country:US
Practice Address - Phone:408-734-2800
Practice Address - Fax:408-734-8455
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68771173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G687710Medicare PIN
CAD15057Medicare UPIN