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Individual

DR. NICHOLAS J TANNOUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
19851 OBSERVATION DR STE 360, GERMANTOWN, MD 20876-4141
(443) 693-7246
(301) 337-6478
Mailing address
2 PARK CENTER CT STE 200, OWINGS MILLS, MD 21117-4221
(443) 693-7246

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
2012005502
MO
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
101263858
VA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
15477
NV
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
2012005502
MO
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
D0084655
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000767742
BCBSMO
MO
01
12355682
CAQH
05
1386817831
NV
Enumeration date
04/04/2008
Last updated
11/26/2018
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