Provider Demographics
NPI:1093371122
Name:TANYA M OSWALD MD PROFESSIONAL LLC
Entity Type:Organization
Organization Name:TANYA M OSWALD MD PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-863-9595
Mailing Address - Street 1:7600 LANDMARK WAY UNIT 1003
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1966
Mailing Address - Country:US
Mailing Address - Phone:303-788-5300
Mailing Address - Fax:303-788-5363
Practice Address - Street 1:601 E HAMPDEN AVE STE 110
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3792
Practice Address - Country:US
Practice Address - Phone:303-788-6445
Practice Address - Fax:303-788-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty