Provider Demographics
NPI:1952304321
Name:TANNA, NITIN K (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:K
Last Name:TANNA
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 4216
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-4216
Mailing Address - Country:US
Mailing Address - Phone:717-412-1295
Mailing Address - Fax:717-509-6362
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-394-6028
Practice Address - Fax:717-394-9223
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064982L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023189YYYOtherMEDICARE PTAN
PA231855378OtherTAX ID - LANC RADIOLOGY
PA300115920OtherRAILROAD MEDICARE
PA023189Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PAF82179Medicare UPIN