Provider Demographics
NPI:1871272112
Name:TAZNIN, TAMANNA (MD)
Entity type:Individual
Prefix:
First Name:TAMANNA
Middle Name:
Last Name:TAZNIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CHELTENHAM DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2534
Mailing Address - Country:US
Mailing Address - Phone:469-957-7792
Mailing Address - Fax:276-439-1872
Practice Address - Street 1:96 15TH ST NW STE 111
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1600
Practice Address - Country:US
Practice Address - Phone:276-439-1872
Practice Address - Fax:276-439-1872
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-P122939-01207R00000X
VA0116038950390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine