MEDICARE: TANNER JOSEPH TRIDICO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MA08057800	NJ

General Provider Information

NPI Number	:	1376581215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNER JOSEPH TRIDICO MD

Provider Business Mailing Address
First Line	:	419 N HARRISON ST
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-3521
Country	:	US
Telephone Number	:	609-924-9300
Fax Number	:	609-430-9481

Provider Business Practice Location Address
First Line	:	419 N HARRISON ST
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-3521
Country	:	US
Telephone Number	:	609-924-9300
Fax Number	:	609-430-9481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/04/2017

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