Basic Information
| Provider Information | |||||||||
| NPI: | 1578096541 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZHANG | ||||||||
| FirstName: | TIANNAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60465 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784660465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773324602 | ||||||||
| FaxNumber: | 3618570572 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072837000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2017 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | S7379 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | DO3447 | ME | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | S7379 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 417867502 | 05 | TX | MEDICAID |