Provider Demographics
NPI:1972644813
Name:TAN, SIGMUND BERNARDINO (DO)
Entity Type:Individual
Prefix:
First Name:SIGMUND
Middle Name:BERNARDINO
Last Name:TAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11848 ROCK LANDING DR
Mailing Address - Street 2:#303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4425
Mailing Address - Country:US
Mailing Address - Phone:757-591-2260
Mailing Address - Fax:757-595-2001
Practice Address - Street 1:11848 ROCK LANDING DR
Practice Address - Street 2:#303
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4425
Practice Address - Country:US
Practice Address - Phone:757-591-2260
Practice Address - Fax:757-595-2001
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202036207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology