Provider Demographics
NPI:1013985258
Name:TABIB, VIRGINIA TAN (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:TAN
Last Name:TABIB
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 1:2600 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-0970
Mailing Address - Country:US
Mailing Address - Phone:219-464-1620
Mailing Address - Fax:219-757-5629
Practice Address - Street 1:8127 MERRILLVILLE RD
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6158
Practice Address - Country:US
Practice Address - Phone:219-769-4855
Practice Address - Fax:219-757-5629
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032934207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5171410004OtherDMERC
IN100208820Medicaid
B29264Medicare UPIN
IN218800DMedicare ID - Type Unspecified