Provider Demographics
NPI:1689764862
Name:TAN BESLIN, MARIA CHARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CHARINA
Last Name:TAN BESLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:CHARINA
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:431 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-3042
Mailing Address - Country:US
Mailing Address - Phone:337-806-9910
Mailing Address - Fax:337-534-0562
Practice Address - Street 1:431 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3042
Practice Address - Country:US
Practice Address - Phone:337-806-9910
Practice Address - Fax:337-534-0562
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201051174400000X
LA201051208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1714763Medicaid
LA1714763Medicaid