| Cheryl Ann Tanasovich, MD | |
|
1300 S Eliseo Dr, Suite 207, Greenbrae, CA 94904-2023 | |
| (415) 925-0550 | |
| (415) 925-9062 |
| Full Name | Cheryl Ann Tanasovich |
|---|---|
| Gender | Female |
| Speciality | Dermatology - Procedural Dermatology |
| Location | 1300 S Eliseo Dr, Greenbrae, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215960844 | NPI | - | NPPES |
| 00G534551 | Other | CA | MEDI-CAL PROVIDER NUMBER |
| 931041613 | Other | CA | TRICARE PROVIDER NUMBER |
| 0004133440 | Other | CA | AETNA PROVIDER NUMBER |
| 00G534550 | Other | CA | BLUE SHIELD PROV # |
| 070003525 | Other | CA | RAILROAD MEDICARE PROV # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207NS0135X | Dermatology - Procedural Dermatology | G53455 (California) | Primary |
| Entity Name | Greenbrae Dermatology, A Medical Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174898654 PECOS PAC ID: 4789832908 Enrollment ID: O20130123000375 |
| Mailing Address | Practice Location Address |
|---|---|
| Cheryl Ann Tanasovich, MD 1300 S Eliseo Dr, Suite 207, Greenbrae, CA 94904-2023 Ph: (415) 925-0550 | Cheryl Ann Tanasovich, MD 1300 S Eliseo Dr, Suite 207, Greenbrae, CA 94904-2023 Ph: (415) 925-0550 |
John L. Maddox, MD Dermatology Medicare: Not Enrolled in Medicare Practice Location: 1300 S Eliseo Dr Ste 207, Greenbrae, CA 94904 Phone: 415-925-0550 Fax: 415-925-9062 | |
Dr. Benjamin Joseph Nichols, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 1300 S Eliseo Dr, Suite 207, Greenbrae, CA 94904 Phone: 415-925-0550 Fax: 415-925-9062 | |
Dr. Diana Deangelis Parnell, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 1100 S Eliseo Dr, Suite 2, Greenbrae, CA 94904 Phone: 415-461-1036 Fax: 415-461-1043 |