Provider Demographics
NPI:1568437069
Name:TA, HA (MD)
Entity Type:Individual
Prefix:
First Name:HA
Middle Name:
Last Name:TA
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:SKAGIT REGIONAL CLINICS, ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:SKAGIT VALLEY HOSPITAL, HOSPITALISTS OFFICE
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4126
Practice Address - Country:US
Practice Address - Phone:360-416-5750
Practice Address - Fax:360-416-5758
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0429415207R00000X
WAMD60287362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA309609OtherLABOR & INDUSTRIES
KS100400710AMedicaid
WA1568437069Medicaid
KS100400710AMedicaid
H47595Medicare UPIN
WA309609OtherLABOR & INDUSTRIES