Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2012005502 | MO |
N | 2081P2900X | Pain Medicine | 101263858 | VA |
N | 2081P2900X | Pain Medicine | 15477 | NV |
N | 2081P2900X | Pain Medicine | 2012005502 | MO |
Y | 2081P2900X | Pain Medicine | D0084655 | MD |
NPI | 1386817831 |
---|---|
Provider Name | Dr. Nicholas J Tannous |
First Address | Owings Mills, MD 21117-4221 |
Second Address | Germantown, MD 20876-4141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2008 |
Last Update Date | 26/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000767742 | BCBSMO (01) | MO |
12355682 | CAQH (01) | |
1386817831 | (05) | NV |