Basic Information
| Provider Information | |||||||||
| NPI: | 1265498851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAN | ||||||||
| FirstName: | DEBBIE-ANN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 277 PLEASANT ST | ||||||||
| Address2: | PRIMA CARE, PC | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027213005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763292 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 277 PLEASANT ST | ||||||||
| Address2: | PRIMA CARE, PC | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027213005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763292 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 08/31/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 81849 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0016214 | 01 | MA | NEIGHBORHOOD HEALTHPLAN | OTHER | 110219104 | 01 | MA | RAILROAD MEDICARE | OTHER | 000000021252 | 01 | MA | BMC HEALTHNET | OTHER | 3144097 | 05 | MA | MEDICAID | 3684747 | 01 | MA | HEALTHSOURCE | OTHER | 204804 | 01 | RI | BLUE CHIP | OTHER | 521354 | 01 | MA | AETNA | OTHER | 65030 | 01 | MA | HARVARD PILGRIM | OTHER | 081849 | 01 | MA | TUFTS HEALTH PLAN | OTHER | B10491501 | 01 | MA | CIGNA | OTHER | 0000029261 | 01 | RI | BLUE SHIELD | OTHER | J16300 | 01 | MA | BLUE SHIELD | OTHER | 0403475 | 01 | MA | UNITED HEALTHCARE | OTHER |