Provider Demographics
NPI:1154314581
Name:TANI, MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:TANI
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:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-357-3100
Mailing Address - Fax:440-357-8254
Practice Address - Street 1:7535 FREDLE DR
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9406
Practice Address - Country:US
Practice Address - Phone:440-357-3100
Practice Address - Fax:440-357-8254
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061372T2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2088682Medicaid
OH000000138278OtherUNICARE
OH106400OtherNATIONWIDE GROUP
OH2135555OtherAETNA SELECT
OH376994OtherSTAYWELL HEALTH/WELLCARE
OH5100755OtherAETNA MANAGED CARE
OH9659200002OtherCIGNA
OH000000138278OtherANTHEM
OH9007447OtherSUMMACARE
OH2088682Medicaid
OH9659200002OtherCIGNA
OH000000138278OtherANTHEM