Peter M Tan, DDS MSHS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

08276 Issued in MD

Practice address

68 Thomas Johnson Dr
Suite a
Frederick, MD 21702

Phone

(301) 694-2300

Fax

(301) 694-7372

NPI assigned

Feb 3, 2006

Last updated

Jun 21, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Sep 1, 2014 through Sep 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mid-Maryland Oral and Maxillofacial Surgery PA

  • Oral and Maxillofacial Surgery Clinic/Center
  • Frederick, MD
  • NPI 1710950399
  NPD (past) Authorized official
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277078400000",
    "number": "1639141609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 THOMAS JOHNSON DR",
            "address_2": "SUITE A",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "21702",
            "telephone_number": "301-694-2300",
            "fax_number": "301-694-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 THOMAS JOHNSON DR",
            "address_2": "SUITE A",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "21702",
            "telephone_number": "301-694-2300",
            "fax_number": "301-694-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "PETER",
        "middle_name": "M",
        "credential": "DDS MSHS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2010-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MD",
            "license": "08276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DENTAL",
            "identifier": "DE94",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "410662",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE PRIME",
            "identifier": "60443",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCCI",
            "identifier": "952901",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL BENEFIT PROVIDERS",
            "identifier": "37385",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cole Brenson Talton, DC
• Vernissia Tam, MD
• Wing Hong Tam, MD
• Malvis N Tamon, DNP, APRN, FNP-BC
• Jiang Tan, L.AC
• Xiao-Wei Cherie Tan, MD
• Tan's TCM Center
• Tandem Rehab Services
• Caiwei Tang
• Michael Xiaobo Tang, PA-C

• Oral & Maxillofacial Surgery (D.M.D.) in Frederick, MD
• Providers in Frederick, MD by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.