Provider Demographics
NPI:1831586072
Name:XU, LUCY TAN (MD)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:TAN
Last Name:XU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAN
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7501 GREENWAY CENTER DR STE 700
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-6703
Mailing Address - Country:US
Mailing Address - Phone:301-441-4577
Mailing Address - Fax:
Practice Address - Street 1:7130 MINSTREL WAY STE LL100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5242
Practice Address - Country:US
Practice Address - Phone:410-997-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.026699207R00000X, 207W00000X
390200000X
GA82297207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program