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NPI Code Detail

MEDICARE: DR. JIE TANG MD, MS, MPH

MEDICARE: DR. JIE TANG MD, MS, MPH
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
1207RN0300XNephrology Physician220678MA
2207RN0300XNephrology PhysicianMD15121RI
3207RN0300XNephrology Physician50140CO

General Provider Information

NPI Number : 1871583997
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JIE TANG MD, MS, MPH
Provider Business Mailing Address
First Line : 17 VIRGINIA AVE 107
Second Line :
City : PROVIDENCE
State : RI
Zip : 02905-4406
Country : US
Telephone Number : 401-443-4992
Fax Number :
Provider Business Practice Location Address
First Line : 375 WAMPANOAG TRL
Second Line : SUITE 302A
City : RIVERSIDE
State : RI
Zip : 02915-2232
Country : US
Telephone Number : 401-649-4060
Fax Number : 401-649-4061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2005
Last Update Date : 09/14/2016

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