Provider Demographics
NPI:1770598260
Name:TAO, JIANGUO (MD)
Entity type:Individual
Prefix:
First Name:JIANGUO
Middle Name:
Last Name:TAO
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 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-9416
Practice Address - Country:US
Practice Address - Phone:888-882-3990
Practice Address - Fax:434-243-6499
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84477207ZP0102X
VA0101273862207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264642600Medicaid
FL15804OtherBLUE CROSS BLUE SHIELD
FLH61855Medicare UPIN
FL264642600Medicaid