Provider Demographics
NPI:1114060621
Name:FRANKLIN, TANYA ELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:ELLIS
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TANYA
Other - Middle Name:KAY
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:550 S JACKSON ST FL ST2
Mailing Address - Street 2:DEPT OB/GYN ATT VICKI MASTERSON
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-271-5999
Practice Address - Fax:502-271-5994
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41890207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000571987OtherANTHEM
KY50019589OtherPASSPORT SPECIALIST
KY50019588OtherPASSPORT SPECIALIST
KY50019590OtherPASSPORT PCP
0000000572860OtherANTHEM
KY7100044470Medicaid
KY0979720Medicare PIN
KY50019590OtherPASSPORT PCP