Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 0116017793 | VA |
NPI | 1316149214 |
---|---|
Provider Name | Dr. Teresa X Tan |
First Address | Newport News, VA 23606-4430 |
Second Address | Newport News, VA 23606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2007 |
Last Update Date | 02/12/2019 |