Provider Demographics
NPI:1437239670
Name:GUO, XIAOTAO (MD)
Entity Type:Individual
Prefix:
First Name:XIAOTAO
Middle Name:
Last Name:GUO
Suffix:
Gender:M
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 3563
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08543-3563
Mailing Address - Country:US
Mailing Address - Phone:972-932-1302
Mailing Address - Fax:972-932-1312
Practice Address - Street 1:253 WITHERSPOON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3211
Practice Address - Country:US
Practice Address - Phone:972-932-1302
Practice Address - Fax:972-932-1312
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ893756Medicare ID - Type Unspecified
NJG37968Medicare UPIN