Provider Demographics
NPI:1235280108
Name:THOR TANGVALD M.D. INC.
Entity Type:Organization
Organization Name:THOR TANGVALD M.D. INC.
Other - Org Name:TANGVALD FRENKEL AND ASSOCIATES OR TANGVALD M.D. AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGVALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-292-3900
Mailing Address - Street 1:103 LANDMARK DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1393
Mailing Address - Country:US
Mailing Address - Phone:859-292-3900
Mailing Address - Fax:859-292-3903
Practice Address - Street 1:103 LANDMARK DR
Practice Address - Street 2:SUITE 240
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1393
Practice Address - Country:US
Practice Address - Phone:859-292-3900
Practice Address - Fax:859-292-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5496Medicare ID - Type Unspecified