Provider Demographics
NPI:1013059781
Name:TANNER, EDWARD JAMES III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAMES
Last Name:TANNER
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:5275 LOUGHBORO RD NW BLDG D
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2633
Practice Address - Country:US
Practice Address - Phone:202-243-5295
Practice Address - Fax:202-537-4662
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-05-01
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Provider Licenses
StateLicense IDTaxonomies
MDD74316207VX0201X
DCMD500002320207VX0201X
NY247219207VX0201X
IL036147391207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD056633100Medicaid
MD056633100Medicaid
MDP19171Medicare UPIN