Provider Demographics
NPI:1396715769
Name:TAN, JESUS HO (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:HO
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-1708
Mailing Address - Country:US
Mailing Address - Phone:301-689-3138
Mailing Address - Fax:301-689-9561
Practice Address - Street 1:4 S BROADWAY
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-1708
Practice Address - Country:US
Practice Address - Phone:301-689-3138
Practice Address - Fax:301-689-9561
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD521167179173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine