Provider Demographics
NPI:1285666818
Name:TAN, TERRY MARIE (DPM)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:MARIE
Last Name:TAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:410-402-2379
Mailing Address - Fax:
Practice Address - Street 1:711 MAIDEN CHOICE LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-3632
Practice Address - Country:US
Practice Address - Phone:410-247-5602
Practice Address - Fax:410-242-1756
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01320213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
138CER-610595-07OtherCAREFIRST BCBS OF MD
MD008203100Medicaid
2701161OtherEVERCARE
610595-07OtherBCBS MD
0045OtherCAREFIRST
0943ER-610595-07OtherCAREFIRST BCBS OF MD
MD008203101Medicaid
MD008203102Medicaid
MD008203100Medicaid
0045OtherCAREFIRST
610595-07OtherBCBS MD
MD008203101Medicaid
590L-M937Medicare PIN