Individual
DARRYL A TANNENBAUM
Active
Individual
DARRYL A TANNENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
1046006
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000195467
ANTHEM
IN
01
—
003842
SIHO
IN
01
—
200040850
RAILROAD MEDICARE
IN
05
—
200127230
—
IN
Enumeration date
06/29/2006
Last updated
01/04/2010
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