Provider Demographics
NPI:1528047784
Name:TIONGSON, ATANACIO HENSON (MD)
Entity type:Individual
Prefix:DR
First Name:ATANACIO
Middle Name:HENSON
Last Name:TIONGSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1556
Mailing Address - Country:US
Mailing Address - Phone:574-722-1212
Mailing Address - Fax:
Practice Address - Street 1:1315 SMITH ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1556
Practice Address - Country:US
Practice Address - Phone:574-722-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028875A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
138340Medicare PIN
B28384Medicare UPIN