Provider Demographics
NPI:1790759025
Name:TAN, JOCELYN L (MD)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:L
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 1:997 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2819
Mailing Address - Country:US
Mailing Address - Phone:724-223-3816
Mailing Address - Fax:724-223-4079
Practice Address - Street 1:997 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2819
Practice Address - Country:US
Practice Address - Phone:724-223-3816
Practice Address - Fax:724-223-4079
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067647L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075893Medicare ID - Type Unspecified
PAF97998Medicare UPIN