MEDICARE: ALLYSON J THATCHER 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
1	251E00000X	Home Health Agency
2	251F00000X	Home Infusion Agency
3	208VP0014X	Interventional Pain Medicine Physician	MD34272	SC

General Provider Information

NPI Number	:	1922047380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON J THATCHER MD

Provider Business Mailing Address
First Line	:	9267 MEDICAL PLAZA DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9139
Country	:	US
Telephone Number	:	843-797-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	9267 MEDICAL PLAZA DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9139
Country	:	US
Telephone Number	:	843-797-3636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	12/18/2019

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