Provider Demographics
NPI:1598056228
Name:TAN, MYRNA MARIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:MARIANO
Last Name:TAN
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 1:617 GEN. LAFAYETTE RD.
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066
Mailing Address - Country:US
Mailing Address - Phone:610-667-8438
Mailing Address - Fax:610-667-8438
Practice Address - Street 1:100 EAST LEHIGH AVE.
Practice Address - Street 2:ESPISCOPAL HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125
Practice Address - Country:US
Practice Address - Phone:215-707-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034942L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology