Provider Demographics
NPI:1467212050
Name:TADJE, JACOB MILLER
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:MILLER
Last Name:TADJE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N TIMBER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5619
Mailing Address - Country:US
Mailing Address - Phone:208-995-3616
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF VERMONT MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-0001
Practice Address - Country:US
Practice Address - Phone:802-656-3806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program