Provider Demographics
NPI:1346354578
Name:VON TAAFFE, NADINE N (MD)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:N
Last Name:VON TAAFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-819-5999
Mailing Address - Fax:912-819-5980
Practice Address - Street 1:5354 REYNOLDS ST
Practice Address - Street 2:STE 424
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6007
Practice Address - Country:US
Practice Address - Phone:912-819-5999
Practice Address - Fax:912-819-5980
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00027596208M00000X
GA067330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051004308OtherBCBS
AL051558297Medicaid
I66022OtherVIVA AND VIVAM
AL1326182486OtherHOSPITAL PHYSICIAN SERVICES OF CENTRAL ALABAMA
ALI66022Medicare UPIN
AL051558297Medicare PIN
AL1326182486OtherHOSPITAL PHYSICIAN SERVICES OF CENTRAL ALABAMA
ALG478Medicare PIN