Provider Demographics
NPI:1104155977
Name:NOEL S TENENBAUM MD PA
Entity type:Organization
Organization Name:NOEL S TENENBAUM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:TENENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-786-6921
Mailing Address - Street 1:220 ALT 19
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5338
Mailing Address - Country:US
Mailing Address - Phone:727-786-6921
Mailing Address - Fax:
Practice Address - Street 1:220 ALT 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5338
Practice Address - Country:US
Practice Address - Phone:727-786-6921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64981208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty