Provider Demographics
NPI:1386754455
Name:TAN, WILLIAM GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GEORGE
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1645 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6521
Mailing Address - Country:US
Mailing Address - Phone:410-795-7737
Mailing Address - Fax:410-795-2828
Practice Address - Street 1:1645 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6521
Practice Address - Country:US
Practice Address - Phone:410-795-7737
Practice Address - Fax:410-795-2828
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD232951400Medicaid
MD5136-5864Medicare ID - Type Unspecified
MD232951400Medicaid