Provider Demographics
NPI:1538448980
Name:TAN, CARLYN ROSE CO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLYN ROSE
Middle Name:CO
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHUN-PIN
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:530 E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3459
Mailing Address - Country:US
Mailing Address - Phone:646-608-3778
Mailing Address - Fax:929-321-8154
Practice Address - Street 1:530 E 74TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3459
Practice Address - Country:US
Practice Address - Phone:646-608-3778
Practice Address - Fax:929-321-8154
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454134207RX0202X
390200000X
NY302078207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program