Individual
DR. RADFORD DOUGLAS TANKSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 SALEM TPKE, SUITE 7, NORWICH, CT 06360-6459
(860) 859-2262
Mailing address
111 SALEM TPKE, SUITE 7, NORWICH, CT 06360-6459
(860) 859-2262
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
030170
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010030170CT02
ANTHEM BCBS
CT
05
—
030170
—
CT
01
—
P00332772
RAILROAD
CT
Enumeration date
02/09/2006
Last updated
08/18/2008
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