Provider Demographics
NPI:1467411959
Name:TAN, MICHELLE H (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:H
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12224 WONDER VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3750
Mailing Address - Country:US
Mailing Address - Phone:240-994-5657
Mailing Address - Fax:301-208-1178
Practice Address - Street 1:600 S FREDERICK AVE
Practice Address - Street 2:STE 302
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1245
Practice Address - Country:US
Practice Address - Phone:301-208-1188
Practice Address - Fax:301-208-1188
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0060871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405459800Medicaid
MDH20080Medicare UPIN
MD405459800Medicaid