Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | MD452312 | PA |
NPI | 1063797017 |
---|---|
Provider Name | Dr. Reina Bianca Medel Tan |
First Address | Philadelphia, PA 19104-4770 |
Second Address | New York, NY 10016-6004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2011 |
Last Update Date | 04/10/2021 |