Provider Demographics
NPI:1427080522
Name:TJOA, PING-AN (MD)
Entity type:Individual
Prefix:
First Name:PING-AN
Middle Name:
Last Name:TJOA
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 1:111 FERGUSON LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4317
Mailing Address - Country:US
Mailing Address - Phone:302-834-1681
Mailing Address - Fax:
Practice Address - Street 1:111 FERGUSON LN
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4317
Practice Address - Country:US
Practice Address - Phone:302-834-1681
Practice Address - Fax:302-834-1681
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-038577-Y207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00089483300Medicaid
PA424832OtherHIGHMARK BLUE SHIELD
6366700OtherCIGNA
PA424832OtherHIGHMARK BLUE SHIELD
6366700OtherCIGNA