Active NPI
Vigilio M Tan, MD
- Ophthalmology Physician
- Martinsburg, WV
National Provider Identifier
1629161815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 13607
- Practice address
- 219 S Spring Street
Martinsburg, WV 25401 - Phone
- (304) 267-9981
- Fax
- (304) 267-5884
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 13607 | WV | Primary |
Addresses
Primary practice location
219 S Spring Street
Martinsburg, WV 25401
Mailing address
219 S Spring Street
Martinsburg, WV 25401
Phone (304) 267-9981
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0096657000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479081600000",
"number": "1629161815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "219 S SPRING STREET",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "25401",
"telephone_number": "304-267-9981",
"fax_number": "304-267-5884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 S SPRING STREET",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "25401",
"telephone_number": "304-267-9981",
"fax_number": "304-267-5884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "VIGILIO",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2016-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WV",
"license": "13607",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0096657000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Martinsburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.