Organization
PAT TANA, M.D., PA
Active
Other names
Peyapong Patanaphan, M.D., PA
Organization subpart
No
Provider details
NPI number
Authorized official
PAT TANA M.D., PA (OWNER)
(410) 922-1661
Entity
Organization
Contact information
Practice address
5400 OLD COURT RD, SUITE 101, RANDALLSTOWN, MD 21133-5100
(410) 922-1661
(410) 922-0365
Mailing address
5400 OLD COURT RD, SUITE 101, RANDALLSTOWN, MD 21133-5100
(410) 922-1661
(410) 922-0365
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D21797
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
979801300
—
MD
Enumeration date
08/06/2008
Last updated
01/07/2009
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