Provider Demographics
NPI:1174624902
Name:TAE Y RHO MD PA
Entity type:Organization
Organization Name:TAE Y RHO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-261-7707
Mailing Address - Street 1:1250 S 18TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034
Mailing Address - Country:US
Mailing Address - Phone:904-261-7707
Mailing Address - Fax:904-261-8616
Practice Address - Street 1:1250 S 18TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-261-7707
Practice Address - Fax:904-261-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME032490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D54913Medicare UPIN
FL45026Medicare ID - Type Unspecified