MEDICARE: JOANNE TANG RD

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	133V00000X	Registered Dietitian	LD.09453	OH

General Provider Information

NPI Number	:	1760203772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE TANG RD

Provider Business Mailing Address
First Line	:	3822 REGENT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3849
Country	:	US
Telephone Number	:	828-577-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	3822 REGENT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3849
Country	:	US
Telephone Number	:	828-577-2323
Fax Number	:

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

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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