Basic Information
| Provider Information | |||||||||
| NPI: | 1639102924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANE | ||||||||
| FirstName: | TYRA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10110 MOLECULAR DR STE 206 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208507542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012792779 | ||||||||
| FaxNumber: | 3012792767 | ||||||||
| Practice Location | |||||||||
| Address1: | 10110 MOLECULAR DR STE 206 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208507542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012792779 | ||||||||
| FaxNumber: | 3012792767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0062009 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2452287 | 01 | UNITED HEALTHCARE | OTHER | 3619618 | 01 | AETNA HMO | OTHER | 0410462 | 05 | MD | MEDICAID | 122144 | 01 | JOHNS HOPKINS HEALTHCARE | OTHER | 700264 | 01 | NCPPO | OTHER | 0088 | 01 | CAREFIRST DC | OTHER | 10345 | 01 | KAISER | OTHER | 407729600 | 05 | MD | MEDICAID | 7529195 | 01 | AETNA PPO | OTHER | 264367 | 01 | COVENTRY | OTHER | 64653201 | 01 | CAREFIRST MARYLAND | OTHER | 8137289 | 01 | MAMSI | OTHER |