Provider Demographics
NPI:1730113226
Name:PRINCE, TANYA E (MD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:E
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 CURRY HOLLOW RD
Mailing Address - Street 2:SUITE100 BUILDING 1
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4631
Mailing Address - Country:US
Mailing Address - Phone:412-650-2375
Mailing Address - Fax:412-650-2324
Practice Address - Street 1:275 CURRY HOLLOW RD
Practice Address - Street 2:SUITE100 BUILDING 1
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4631
Practice Address - Country:US
Practice Address - Phone:412-650-2375
Practice Address - Fax:412-650-2324
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420122207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW101083083Medicaid
PAI11100Medicare UPIN
PW101083083Medicaid