Provider Demographics
NPI:1467654376
Name:OSWALD, TANYA MONIQUE (MD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MONIQUE
Last Name:OSWALD
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 1:13111 E BRIARWOOD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3925
Mailing Address - Country:US
Mailing Address - Phone:720-408-5805
Mailing Address - Fax:720-930-4252
Practice Address - Street 1:13111 E BRIARWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3925
Practice Address - Country:US
Practice Address - Phone:720-408-5805
Practice Address - Fax:720-930-4252
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00551262082S0105X, 208600000X, 2086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46987291Medicaid
CO46987291Medicaid
MS302I248274Medicare PIN
SCG07209Medicaid
MS05606851Medicaid