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NPI Code Detail

MEDICARE: DAT THANH TA MD

MEDICARE: DAT THANH TA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician2013-00142NC

General Provider Information

NPI Number : 1194049049
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAT THANH TA MD
Provider Business Mailing Address
First Line : 101 E WOOD ST
Second Line :
City : SPARTANBURG
State : SC
Zip : 29303-3040
Country : US
Telephone Number : 864-560-6000
Fax Number :
Provider Business Practice Location Address
First Line : 10628 PARK RD
Second Line : EMERGENCY DEPARTMENT
City : CHARLOTTE
State : NC
Zip : 28210-8407
Country : US
Telephone Number : 877-678-0949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2010
Last Update Date : 04/17/2026

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