Provider Demographics
NPI:1508848011
Name:TAN, CONSTANTE J (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANTE
Middle Name:J
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1340 S DIVISION ST
Mailing Address - Street 2:STE 301
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6921
Mailing Address - Country:US
Mailing Address - Phone:410-546-4427
Mailing Address - Fax:410-546-2096
Practice Address - Street 1:1340 S DIVISION ST
Practice Address - Street 2:STE 301
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6921
Practice Address - Country:US
Practice Address - Phone:410-546-4427
Practice Address - Fax:410-546-2096
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MDD0016725207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
T996Medicare ID - Type Unspecified
D74767Medicare UPIN