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Individual

SHLOMO MARK TANEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
11702 GAINSBOROUGH RD, POTOMAC, MD 20854-3246
(703) 201-0830
Mailing address
11702 GAINSBOROUGH RD, POTOMAC, MD 20854-3246
(703) 201-0830

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0130000215
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00-60-2846-2
VA
01
0130000215
BOARD OF MEDICINE LICENSE
VA
01
085814
ANTHEM
VA
01
A302-0001
BCBSNCA
VA
Enumeration date
06/04/2006
Last updated
11/22/2023
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