Provider Demographics
NPI:1679521496
Name:TAN, MARIE KWAI-CHE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:KWAI-CHE
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:KWAI-CHE
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3344 ROUTE 130,
Mailing Address - Street 2:SUITE A, PO BOX 415,
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-0415
Mailing Address - Country:US
Mailing Address - Phone:724-744-3660
Mailing Address - Fax:724-744-3815
Practice Address - Street 1:3344 ROUTE 130
Practice Address - Street 2:SUITE A,
Practice Address - City:HARRISON CITY
Practice Address - State:PA
Practice Address - Zip Code:15636-1238
Practice Address - Country:US
Practice Address - Phone:724-744-3660
Practice Address - Fax:724-744-3815
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-041730-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE92677Medicare UPIN