Provider Demographics
NPI:1689737397
Name:TAN, JOSEFINA C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:C
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 1:106 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-2917
Mailing Address - Country:US
Mailing Address - Phone:912-527-1000
Mailing Address - Fax:
Practice Address - Street 1:106 E BROAD ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-2917
Practice Address - Country:US
Practice Address - Phone:912-527-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019193208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
10063432OtherAMERIGROUP
GA469298310AMedicaid
GA08BBWTSMedicare ID - Type Unspecified
10063432OtherAMERIGROUP