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NPI Code Detail

MEDICARE: DR. ANTHONY JOHN TACKMAN M.D.

MEDICARE: DR. ANTHONY JOHN TACKMAN 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
1208000000XPediatrics Physician9901045NC
22080N0001XNeonatal-Perinatal Medicine Physician9901045NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306855689
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTHONY JOHN TACKMAN M.D.
Provider Business Mailing Address
First Line : 3024 NEW BERN AVE
Second Line : SUITE 300
City : RALEIGH
State : NC
Zip : 27610-1247
Country : US
Telephone Number : 919-350-8228
Fax Number : 919-350-7976
Provider Business Practice Location Address
First Line : 3000 NEW BERN AVE
Second Line : NEONATOLOGY DEPT.
City : RALEIGH
State : NC
Zip : 27610-1231
Country : US
Telephone Number : 919-350-8545
Fax Number : 919-350-8146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 04/09/2010

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