Provider Demographics
NPI:1306838263
Name:MAXINE C TABAS MD PA
Entity Type:Organization
Organization Name:MAXINE C TABAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TABAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-647-7300
Mailing Address - Street 1:1901 LEE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1834
Mailing Address - Country:US
Mailing Address - Phone:407-647-7300
Mailing Address - Fax:407-647-5496
Practice Address - Street 1:1901 LEE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1834
Practice Address - Country:US
Practice Address - Phone:407-647-7300
Practice Address - Fax:407-647-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1968Medicare ID - Type Unspecified