MEDICARE: ANGELA GARDNER THATCHER PA-C

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	363A00000X	Physician Assistant	0010-07039	NC

General Provider Information

NPI Number	:	1356889521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA GARDNER THATCHER PA-C

Provider Business Mailing Address
First Line	:	525 S WHITE ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2920
Country	:	US
Telephone Number	:	919-435-2154
Fax Number	:	888-355-2154

Provider Business Practice Location Address
First Line	:	525 S WHITE ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2920
Country	:	US
Telephone Number	:	919-435-2154
Fax Number	:	888-355-2154

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

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	05/16/2023

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