Provider Demographics
NPI:1801810668
Name:TAN, SHARON (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:TAN
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 1:41 N MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1972
Mailing Address - Country:US
Mailing Address - Phone:860-313-0448
Mailing Address - Fax:860-313-1464
Practice Address - Street 1:41 N MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1972
Practice Address - Country:US
Practice Address - Phone:860-313-0448
Practice Address - Fax:860-313-1464
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03900207RG0300X
CT039000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN010039000CT02OtherANTHEM BLUE SHIELD
CT001390004Medicaid
2V5173OtherHEALTHNET
CT001390004Medicaid
TN010039000CT02OtherANTHEM BLUE SHIELD