Basic Information
| Provider Information | |||||||||
| NPI: | 1295933653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TENNER | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | GAIL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 S PACA ST FL 6 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103288025 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 S PACA ST FL 6 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103288025 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 125050033 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 60257667 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036080967 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 60257667 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | D0073918 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | D0073918 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.