Provider Demographics
NPI:1316437783
Name:TAN RENEHAN, SALLY (MD, MPH)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:TAN RENEHAN
Suffix:
Gender:
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BAKER AVE STE N220
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2190
Mailing Address - Country:US
Mailing Address - Phone:978-254-1600
Mailing Address - Fax:
Practice Address - Street 1:290 BAKER AVE STE N220
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2190
Practice Address - Country:US
Practice Address - Phone:978-254-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program