Provider Demographics
NPI:1801894605
Name:TAN, ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:TAN
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 1:3101 DEERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1521
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:412-457-0067
Practice Address - Street 1:3101 DEERFIELD CT
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1521
Practice Address - Country:US
Practice Address - Phone:412-457-0060
Practice Address - Fax:412-457-0067
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027410E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010007580001Medicaid
PAC29169Medicare UPIN
PATA077421EPAMedicare ID - Type Unspecified