Provider Demographics
NPI:1316149214
Name:TAN, TERESA X (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:X
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8866
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-223-9794
Practice Address - Fax:757-223-9168
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0116017793207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA018290T328Medicare PIN