Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | C10010131 | DE |
Y | 111NI0900X | Internist | C10010131 | DE |
NPI | 1003046624 |
---|---|
Provider Name | Theodore Conrad Ang Tan |
First Address | Dover, DE 19904-5488 |
Second Address | Dover, DE 19904-5488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 28/12/2015 |