Provider Demographics
NPI:1821010067
Name:TAN, WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3000 NEW BERN AVE STE 1100
Mailing Address - Street 2:WPP - STRUCTURAL HEART
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-232-5202
Mailing Address - Fax:919-231-6334
Practice Address - Street 1:3000 NEW BERN AVE STE 1100
Practice Address - Street 2:WPP - STRUCTURAL HEART
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-232-5202
Practice Address - Fax:919-231-6334
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200201012207RC0000X, 207RI0011X, 2085R0204X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131VTOtherBCBSNC
NCP00418889OtherMEDICARE RAILROAD
NC190783OtherMEDCOST
NC89131VTMedicaid
NC2006372AMedicare PIN
NC190783OtherMEDCOST