Provider Demographics
NPI:1972741122
Name:TAN, PAMELA (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
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 1:4401 E WEST HWY
Mailing Address - Street 2:STE 208
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4531
Mailing Address - Country:US
Mailing Address - Phone:301-941-7481
Mailing Address - Fax:520-363-6186
Practice Address - Street 1:4401 E WEST HWY
Practice Address - Street 2:STE 208
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4531
Practice Address - Country:US
Practice Address - Phone:202-476-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2071402086S0122X
MDD851682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty