Provider Demographics
NPI:1649234238
Name:GOLUB, TATYANA V (MD)
Entity Type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:V
Last Name:GOLUB
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1455 25TH AVE DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9655
Mailing Address - Country:US
Mailing Address - Phone:828-322-4453
Mailing Address - Fax:828-324-9295
Practice Address - Street 1:1375 4TH STREET DR NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2523
Practice Address - Country:US
Practice Address - Phone:828-322-4453
Practice Address - Fax:828-324-9295
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200501272208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902098Medicaid
BG9370898OtherDEA NUMBER
NCI39516Medicare UPIN