Provider Demographics
NPI:1316059603
Name:SANSES, TATIANA V (MD)
Entity type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:V
Last Name:SANSES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVE NW FACULTY PRACTICE PLAN SUITE 6101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-6679
Mailing Address - Fax:202-865-3138
Practice Address - Street 1:2041 GEORGIA AVE NW FACULTY PRACTICE PLAN TOWER 1700
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-1734
Practice Address - Country:US
Practice Address - Phone:202-865-4164
Practice Address - Fax:202-865-7407
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD045673207V00000X
OH35-094680207V00000X
MDD64589207V00000X, 207VF0040X
DCMD45673207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKJ43/89152801OtherCAREFIRST MARYLAND GBMC
OH3010057Medicaid
MD411903700Medicaid
MDS1400042OtherCAREFIRST REGIONAL GBMC
OHSA4282231Medicare PIN
MD332013ZAN5Medicare PIN
MDKJ43/89152801OtherCAREFIRST MARYLAND GBMC