Provider Demographics
NPI:1639102924
Name:KANE, TYRA D (MD)
Entity Type:Individual
Prefix:DR
First Name:TYRA
Middle Name:D
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10110 MOLECULAR DR STE 206
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7542
Mailing Address - Country:US
Mailing Address - Phone:301-279-2779
Mailing Address - Fax:301-279-2767
Practice Address - Street 1:10110 MOLECULAR DR STE 206
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7542
Practice Address - Country:US
Practice Address - Phone:301-279-2779
Practice Address - Fax:301-279-2767
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2452287OtherUNITED HEALTHCARE
3619618OtherAETNA HMO
MD0410462Medicaid
122144OtherJOHNS HOPKINS HEALTHCARE
700264OtherNCPPO
0088OtherCAREFIRST DC
10345OtherKAISER
MD407729600Medicaid
7529195OtherAETNA PPO
264367OtherCOVENTRY
64653201OtherCAREFIRST MARYLAND
8137289OtherMAMSI
700264OtherNCPPO
3619618OtherAETNA HMO
MD407729600Medicaid
0088OtherCAREFIRST DC