Provider Demographics
NPI:1528388030
Name:TANG, TANYA TOCHAROEN (DO)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:TOCHAROEN
Last Name:TANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 DILLON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307
Mailing Address - Country:US
Mailing Address - Phone:864-327-1212
Mailing Address - Fax:864-327-1211
Practice Address - Street 1:126 DILLON DR.
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307
Practice Address - Country:US
Practice Address - Phone:864-327-1212
Practice Address - Fax:864-327-1211
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013467207R00000X
SC1630207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC64073617Medicare PIN