Provider Demographics
NPI:1386612877
Name:TORRES, MARIA PRECIOUS TANGAN (MD)
Entity type:Individual
Prefix:
First Name:MARIA PRECIOUS
Middle Name:TANGAN
Last Name:TORRES
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 1:100 VICAR PL
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-1396
Mailing Address - Country:US
Mailing Address - Phone:434-836-5676
Mailing Address - Fax:434-836-5874
Practice Address - Street 1:2100 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1628
Practice Address - Country:US
Practice Address - Phone:434-517-8022
Practice Address - Fax:434-517-8022
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA241073OtherBCBS
VA006714978Medicaid
VA44904OtherOPTIMA
VA370000819Medicare ID - Type Unspecified
VAG32635Medicare UPIN