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General NPI Number Information
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NPI Number | 1720105810
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Entity Type | Organization
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Legal Business Name | TAKOMA REGIONAL HOSPITAL DBA TAKOMA MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 401 TAKOMA AVE
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City | GREENEVILLE
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State | TN
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Zip | 37743-4647
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Country | US
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Telephone | 423-636-3151
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37087
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City | BALTIMORE
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State | MD
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Zip | 21297-3807
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Country | US
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Telephone | 423-224-3250
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Fax | 423-224-3258
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Authorized Official
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Title or Position | CFO
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Name | TODD J DOUGAN
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Credential |
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Telephone | 423-230-8512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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