Provider Demographics
NPI:1194983080
Name:DRS TANNENBAUM AND TYLER LLC
Entity type:Organization
Organization Name:DRS TANNENBAUM AND TYLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:TANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-569-9429
Mailing Address - Street 1:2012 S TOLLGATE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5900
Mailing Address - Country:US
Mailing Address - Phone:410-569-9429
Mailing Address - Fax:410-569-9423
Practice Address - Street 1:2012 S TOLLGATE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5900
Practice Address - Country:US
Practice Address - Phone:410-569-9429
Practice Address - Fax:410-569-9423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD127LMedicare PIN