Individual
DR. JONATHAN ETHAN TANNEBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
251 N 4TH ST, OAKLAND, MD 21550-1375
(301) 533-4000
(301) 895-8751
Mailing address
908 NIAGARA FALLS BLVD STE 208, NORTH TONAWANDA, NY 14120-2019
(716) 692-3302
(716) 692-4342
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
275818
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1H0698
MEDICAR PTAN
MD
05
—
996022880
—
MD
Enumeration date
07/19/2011
Last updated
08/16/2021
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