Provider Demographics
NPI:1215377577
Name:ZHANG, RUONAN (LOM)
Entity Type:Individual
Prefix:MS
First Name:RUONAN
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:LOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3216
Mailing Address - Country:US
Mailing Address - Phone:484-477-7634
Mailing Address - Fax:
Practice Address - Street 1:14 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3216
Practice Address - Country:US
Practice Address - Phone:484-477-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30514089OtherDRIVER'S LICENSE