Provider Demographics
NPI:1750349023
Name:TANZER, FREDERICK L (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:L
Last Name:TANZER
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:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-0298
Mailing Address - Country:US
Mailing Address - Phone:513-543-3746
Mailing Address - Fax:513-247-9284
Practice Address - Street 1:1275 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8273
Practice Address - Country:US
Practice Address - Phone:937-393-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0904721Medicaid
000000361503OtherBCBS
P00241472OtherRAIL ROAD MEDICARE
OH110066520Medicare PIN
000000361503OtherBCBS
P00241472OtherRAIL ROAD MEDICARE
E65564Medicare UPIN
OH0904721Medicaid
OH9294111Medicare PIN