Provider Demographics
NPI:1104824630
Name:TJAN, VIRGINIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:M
Last Name:TJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5711
Mailing Address - Country:US
Mailing Address - Phone:970-497-8001
Mailing Address - Fax:970-240-7793
Practice Address - Street 1:600 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5711
Practice Address - Country:US
Practice Address - Phone:970-497-8001
Practice Address - Fax:970-240-7793
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036026207RH0003X
CO47519207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18480373Medicaid
CT001360263Medicaid
CO18480373Medicaid
COCO305567Medicare PIN
CTG53899Medicare UPIN