Provider Demographics
NPI:1568941474
Name:TANGNEY, THOMAS JEREMIAH
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JEREMIAH
Last Name:TANGNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:J
Other - Last Name:TANGNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TJ
Mailing Address - Street 1:3011 BURKHART ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-5564
Mailing Address - Country:US
Mailing Address - Phone:541-215-0958
Mailing Address - Fax:
Practice Address - Street 1:35 MULLINS DR STE 3
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3985
Practice Address - Country:US
Practice Address - Phone:541-451-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator