Provider Demographics
NPI:1710947114
Name:TAN, TOM XIAOLIN (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:XIAOLIN
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:PO BOX 5128
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-5128
Mailing Address - Country:US
Mailing Address - Phone:419-224-5707
Mailing Address - Fax:419-229-0040
Practice Address - Street 1:730 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4602
Practice Address - Country:US
Practice Address - Phone:419-227-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0699602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300117618OtherRAILROAD MEDICARE
OH000000177814OtherANTHEM BCBS
OH300111996OtherRAILROAD MEDICARE
OH2193791Medicaid
OH300117618OtherRAILROAD MEDICARE
OH300111996OtherRAILROAD MEDICARE
OHTA4024132Medicare ID - Type Unspecified
OHTA4024133Medicare ID - Type Unspecified