1033154323 NPI number — RONALD MICHAEL TADDEO MD

Table of content: RONALD MICHAEL TADDEO MD (NPI 1033154323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033154323 NPI number — RONALD MICHAEL TADDEO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TADDEO
Provider First Name:
RONALD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TADDEO
Provider Other First Name:
RONALD
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033154323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 AFRICA RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-9808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-891-8080
Provider Business Mailing Address Fax Number:
614-891-7078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 AFRICA RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-891-8080
Provider Business Practice Location Address Fax Number:
614-891-7078
Provider Enumeration Date:
06/19/2006

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:  35.075169 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2220724 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".