Provider Demographics
NPI:1699723213
Name:TAN, JEREMIAS C (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMIAS
Middle Name:C
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3700 JOSEPH SIEWICK DR STE 308
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1739
Mailing Address - Country:US
Mailing Address - Phone:703-698-8960
Mailing Address - Fax:703-716-8703
Practice Address - Street 1:3700 JOSEPH SIEWICK DR STE 308
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-698-8960
Practice Address - Fax:647-646-4744
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101239223207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
302447OtherANTHEM BCBS
302474OtherANTHEM BCBS
346674OtherANTHEM BCBS
206263OtherANTHEM BCBS
206265OtherANTHEM BCBS
VA0101239223OtherSTATE LICENSE
341909OtherANTHEM BCBS
79160018OtherCAREFIRST BCBS
VA1699723213Medicaid
VA1699723213Medicaid
VA0101239223OtherSTATE LICENSE
346674OtherANTHEM BCBS