Provider Demographics
NPI:1134276413
Name:TENNANT, STANLEY NEAL (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:NEAL
Last Name:TENNANT
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 1:1002 N CHURCH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1439
Mailing Address - Country:US
Mailing Address - Phone:336-272-6133
Mailing Address - Fax:
Practice Address - Street 1:1002 N CHURCH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1439
Practice Address - Country:US
Practice Address - Phone:336-272-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26995207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060042000OtherRR MEDICARE
NC82409OtherBCBS NC
437OtherPARTNERS MEDICARE
2500041OtherUNITED HEALTHCARE
437OtherPARTNERS
561240263OtherCOMMERCIAL
NC8982409Medicaid
C86728Medicare UPIN
210898CMedicare ID - Type Unspecified