Provider Demographics
NPI:1639163520
Name:TAN, VINCENT (MD)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HAMPTON RD
Mailing Address - Street 2:BLDG# 3
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4831
Mailing Address - Country:US
Mailing Address - Phone:603-775-0000
Mailing Address - Fax:603-775-0247
Practice Address - Street 1:21 HAMPTON RD
Practice Address - Street 2:BLDG 3
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4831
Practice Address - Country:US
Practice Address - Phone:603-775-0000
Practice Address - Fax:603-775-0247
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3082917Medicaid
NH080151642OtherRAILROAD MEDICARE
NHBX9236Medicare PIN
NHG33719Medicare UPIN