Tanen, Shlomo Mark

Tanen, Shlomo Mark is an sole proprietor health care provider with primary practice located at 11702 Gainsborough Rd , Potomac MD 20854-3246. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Tanen, Shlomo Mark can be contacted via phone (703) 201-0830.

Contact Information

Primary practice address
11702 Gainsborough Rd Potomac MD 20854-3246
Phone: (703) 201-0830
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 0130000215 Virginia

Profile Details

NPI number 1174562540
LBN Legal business name Tanen, Shlomo Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 4th, 2006
Last updated Nov 22nd, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174562540 NPPES
Virginia Other 0130000215 BOARD OF MEDICINE LICENSE
Virginia MEDICAID 00-60-2846-2 BOARD OF MEDICINE LICENSE
Virginia Other 085814 BOARD OF MEDICINE LICENSE
Virginia Other A302-0001 BOARD OF MEDICINE LICENSE

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