Basic Information
| Provider Information | |||||||||
| NPI: | 1316059603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANSES | ||||||||
| FirstName: | TATIANA | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2041 GEORGIA AVE NW FACULTY PRACTICE PLAN SUITE 6101 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028656679 | ||||||||
| FaxNumber: | 2028653138 | ||||||||
| Practice Location | |||||||||
| Address1: | 2041 GEORGIA AVE NW FACULTY PRACTICE PLAN TOWER 1700 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200601734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028654164 | ||||||||
| FaxNumber: | 2028657407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 12/19/2018 | ||||||||
| 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 | 207V00000X | MD045673 | DC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 35-094680 | OH | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D64589 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VF0040X | D64589 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery | 207VF0040X | MD45673 | DC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | KJ43/89152801 | 01 | MD | CAREFIRST MARYLAND GBMC | OTHER | 3010057 | 05 | OH | MEDICAID | 411903700 | 05 | MD | MEDICAID | S1400042 | 01 | MD | CAREFIRST REGIONAL GBMC | OTHER |