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NPI Code Detail

MEDICARE: DR. THIRATH CHAU M.D.

MEDICARE: DR. THIRATH CHAU M.D.
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
1207Q00000XFamily Medicine Physician036127335IL
2207Q00000XFamily Medicine PhysicianME108063FL
3207Q00000XFamily Medicine Physician42559AL
4207Q00000XFamily Medicine Physician2019-01621NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036127335OTHERILMEDICAL LICENSE
2ME108063OTHERFLMEDICAL LICENSE
3TRN12590OTHERFLTRAINING LICENSE

General Provider Information

NPI Number : 1285896720
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THIRATH CHAU M.D.
Provider Business Mailing Address
First Line : PO BOX 746724
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6724
Country : US
Telephone Number : 312-733-9730
Fax Number : 773-866-8014
Provider Business Practice Location Address
First Line : 3250 FREEDOM DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-2817
Country : US
Telephone Number : 704-709-6009
Fax Number : 704-899-0470
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2008
Last Update Date : 06/29/2022

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