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Individual

DR. IRENE J. TAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
9880 BUSTLETON AVE, PHILADELPHIA, PA 19115-2185
(215) 827-1500
(215) 827-1501
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-4600
(215) 707-4034

Taxonomy

Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
MD445427
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010037521CT01
BCBS PROVIDER ID
CT
01
1891982005
GROUP NPI
CT
01
2V7063
HEALTH NET PROVIDER ID
CT
01
C03453
MEDICARE GROUP PIN
CT
Enumeration date
01/26/2006
Last updated
11/06/2020
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