Provider Demographics
NPI:1740369560
Name:LEHINE, TANYA (DO)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:LEHINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 IRON DUKE CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2370
Mailing Address - Country:US
Mailing Address - Phone:518-321-7090
Mailing Address - Fax:
Practice Address - Street 1:4235 IRON DUKE CT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30097-2370
Practice Address - Country:US
Practice Address - Phone:518-321-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228190207Q00000X
GA75989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02566067Medicaid
NYP00882777OtherRR MEDICARE
I03933Medicare UPIN
NYP00882777OtherRR MEDICARE