Provider Demographics
NPI:1710990395
Name:TANK, CAROLYN S (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:TANK
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 1:2525 S DOWNING ST
Mailing Address - Street 2:UNIT 1-SOUTH PORTER ADVENTIST HOSPITAL
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5876
Mailing Address - Country:US
Mailing Address - Phone:303-778-5811
Mailing Address - Fax:303-765-3792
Practice Address - Street 1:2525 S DOWNING ST
Practice Address - Street 2:UNIT 1-SOUTH PORTER ADVENTIST HOSPITAL
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5876
Practice Address - Country:US
Practice Address - Phone:303-778-5811
Practice Address - Fax:303-765-3792
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO257082084P0800X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15839362Medicaid
385368Medicare ID - Type Unspecified
CO15839362Medicaid