1639102924 NPI number — DR. TYRA D KANE M.D.

Table of content: DR. TYRA D KANE M.D. (NPI 1639102924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639102924 NPI number — DR. TYRA D KANE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANE
Provider First Name:
TYRA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639102924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10110 MOLECULAR DR STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-7542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-279-2779
Provider Business Mailing Address Fax Number:
301-279-2767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10110 MOLECULAR DR STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-7542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-279-2779
Provider Business Practice Location Address Fax Number:
301-279-2767
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0062009 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2452287 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3619618 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0410462 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122144 . This is a "JOHNS HOPKINS HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700264 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0088 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10345 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 407729600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7529195 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 264367 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64653201 . This is a "CAREFIRST MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8137289 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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