=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225291339
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELINDA ANN THIAM MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2008
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MADIGAN ARMY MEDICAL CTR
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98431-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-0770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1911 GADSDEN ST STE 101
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29201-6400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-851-0651
-----------------------------------------------------
Fax | 213-203-2258
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 40020
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------