Provider Demographics
NPI:1063797017
Name:TAN, REINA BIANCA MEDEL (MD)
Entity type:Individual
Prefix:DR
First Name:REINA BIANCA
Middle Name:MEDEL
Last Name:TAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 SPRUCE ST APT B6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4770
Mailing Address - Country:US
Mailing Address - Phone:718-710-5224
Mailing Address - Fax:
Practice Address - Street 1:160 E 32ND ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6004
Practice Address - Country:US
Practice Address - Phone:212-263-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4523122080P0202X
NY2952202080P0202X, 207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology