Provider Demographics
NPI:1750468914
Name:NOH, TAE J (MD)
Entity Type:Individual
Prefix:DR
First Name:TAE
Middle Name:J
Last Name:NOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:TJ
Other - Last Name:NOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8495 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3729
Mailing Address - Country:US
Mailing Address - Phone:813-920-2400
Mailing Address - Fax:813-792-0001
Practice Address - Street 1:8495 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3729
Practice Address - Country:US
Practice Address - Phone:813-920-2400
Practice Address - Fax:813-792-0001
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84038207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH70885Medicare UPIN
FL28009Medicare ID - Type Unspecified