Provider Demographics
NPI:1972587103
Name:QUIEN, EMMANUEL TAN (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:TAN
Last Name:QUIEN
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-728-2500
Mailing Address - Fax:215-728-3639
Practice Address - Street 1:333 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2434
Practice Address - Country:US
Practice Address - Phone:215-728-2500
Practice Address - Fax:215-728-3639
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050469L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1400OtherBRAVO HEALTH
PA3Y2515OtherHEALTH NET
PA5288554OtherAETNA PPO
PA906433OtherHIGHMARK BLUE SHIELD
PA0164374901OtherAMERICHOICE
PA0416629000OtherINDEPENDENCE BLUE CROSS
PA519042OtherCOVENTRY HEALTH AMERICA
PAP00025016OtherRAILROAD MEDICARE
PA001643749Medicaid
PA1064956OtherKEYSTONE MERCY HEALTH
PA3215831OtherAETNA HMO
PA3215831OtherAETNA HMO
PA906433Medicare PIN