MEDICARE: THAO HOANG PA

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	207X00000X	Orthopaedic Surgery Physician	0110011127	VA
2	363A00000X	Physician Assistant	0110011127	VA

General Provider Information

NPI Number	:	1003703786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAO HOANG PA

Provider Business Mailing Address
First Line	:	PO BOX 749112
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9112
Country	:	US
Telephone Number	:	434-295-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1045
Country	:	US
Telephone Number	:	800-995-4682
Fax Number	:

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

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	12/02/2025

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Directions to “ THAO HOANG PA” Practice Location

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