Provider Demographics
NPI:1073667168
Name:REEMA TANEJA, M.D., INC.
Entity Type:Organization
Organization Name:REEMA TANEJA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-726-1900
Mailing Address - Street 1:1240 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4044
Mailing Address - Country:US
Mailing Address - Phone:330-726-1900
Mailing Address - Fax:330-726-0843
Practice Address - Street 1:1240 BOARDMAN CANFIELD RD
Practice Address - Street 2:SUITE # 1
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4044
Practice Address - Country:US
Practice Address - Phone:330-726-1900
Practice Address - Fax:330-726-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2394083Medicaid
OH2394083Medicaid