Provider Demographics
NPI:1235176611
Name:TAN, AMY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:TAN
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 1:12 LANDING RD S
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04640-3522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 S ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620
Practice Address - Country:US
Practice Address - Phone:509-773-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19928208600000X
MEMD16499208600000X
MO2021025788208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
100671OtherANTHEM
AA74226OtherHARVARD PILGRIM
NH3119994Medicaid
MEHX4748OtherMED B - PERSONAL FOR BHMH
MEME065001Medicare PIN
MEME0650Medicare PIN
100671OtherANTHEM