Provider Demographics
NPI:1538302187
Name:TAN, JONATHAN M (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:TAN
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Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:THE WANAMAKER BLDG., 9TH FL, N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9300
Mailing Address - Fax:267-425-9331
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:MAIN BUILDING, 9TH FLOOR, SUITE #9329
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1866
Practice Address - Fax:215-590-1415
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2017-01-18
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Provider Licenses
StateLicense IDTaxonomies
PAMD449265207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA445669EJLMedicare UPIN