Provider Demographics
NPI:1306120308
Name:NDONG, TIDIANE
Entity type:Individual
Prefix:
First Name:TIDIANE
Middle Name:
Last Name:NDONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4979 OLDE COVENTRY RD W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-2684
Mailing Address - Country:US
Mailing Address - Phone:614-226-8323
Mailing Address - Fax:
Practice Address - Street 1:4979 OLDE COVENTRY RD W
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2684
Practice Address - Country:US
Practice Address - Phone:614-226-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide