1902349426 NPI number — TARA RONDEAU MS, LCDP

Table of content: TARA RONDEAU MS, LCDP (NPI 1902349426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902349426 NPI number — TARA RONDEAU MS, LCDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RONDEAU
Provider First Name:
TARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LCDP
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:
1902349426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 S COUNTY COMMONS WAY
Provider Second Line Business Mailing Address:
UNIT 49 F6
Provider Business Mailing Address City Name:
SOUTH KINGSTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02879-8269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-783-2220
Provider Business Mailing Address Fax Number:
401-783-2224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 S COUNTY COMMONS WAY
Provider Second Line Business Practice Location Address:
UNIT 49 F6
Provider Business Practice Location Address City Name:
SOUTH KINGSTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02879-8269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-783-2220
Provider Business Practice Location Address Fax Number:
401-783-2224
Provider Enumeration Date:
12/01/2016

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: CDP00773 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CDP00773 . This is a "STATE OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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