Provider Demographics
NPI:1851356448
Name:TAN, SHIRLEY (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
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 1:243 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743
Mailing Address - Country:US
Mailing Address - Phone:603-542-6700
Mailing Address - Fax:603-542-6703
Practice Address - Street 1:7 DUNNING STREET
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743
Practice Address - Country:US
Practice Address - Phone:603-542-6700
Practice Address - Fax:603-542-6703
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9263208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077278Medicaid
VT1014012Medicaid
NH3077278Medicaid
IA529109OtherIOWA HEALTH SOLUTIONS
VT1014012Medicaid
IA16562Medicare ID - Type Unspecified
IA03276OtherWELLMARK BLUE CROSS