Alice Tanner M.D.,PC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

ALICE TANNER M.D.,PC

Practice address

1406 Crain Hwy S
Suite 104
Glen Burnie, MD 21061-4058

Phone

(410) 768-2231

Fax

(410) 760-4522

NPI assigned

May 8, 2008

Last updated

May 8, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Alice Patricia Tanner, M.D.

Title

Pediatrician/Practice Owner

Phone

(410) 768-2231

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210204800000",
    "number": "1013184159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 CRAIN HWY S",
            "address_2": "SUITE 104",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614058",
            "telephone_number": "410-768-2231",
            "fax_number": "410-760-4522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 CRAIN HWY S",
            "address_2": "SUITE 104",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614058",
            "telephone_number": "410-768-2231",
            "fax_number": "410-760-4522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALICE TANNER M.D.,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2008-05-08",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "PEDIATRICIAN/PRACTICE OWNER",
        "authorized_official_telephone_number": "410-768-2231",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "215896500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Adolescent Medicine Physician in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Pediatric Adolescent Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.