Healthcare Provider Details

I. General information

NPI: 1548366974
Provider Name (Legal Business Name): DERYA UCAR TAGGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST RH JOHNSON VAMC, SERVICE 112
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

775 NAVIGATORS RUN
MOUNT PLEASANT SC
29464-6620
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7330
  • Fax:
Mailing address:
  • Phone: 843-789-7330
  • Fax: 843-937-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number16645
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number16645
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number16645
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number16645
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: