# ALICE TANNER M.D.,PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013184159
- **Authorized official:** DR. ALICE PATRICIA TANNER M.D. (PEDIATRICIAN/PRACTICE OWNER)
- **Authorized official phone:** (410) 768-2231

## Contact information

- **Practice address:** 1406 CRAIN HWY S, SUITE 104, GLEN BURNIE, MD 21061-4058
- **Practice address phone:** (410) 768-2231
- **Practice address fax:** (410) 760-4522
- **Mailing address:** 1406 CRAIN HWY S, SUITE 104, GLEN BURNIE, MD 21061-4058
- **Mailing address phone:** (410) 768-2231
- **Mailing address fax:** (410) 760-4522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/08/2008
- **Last updated:** 05/08/2008