Provider Demographics
NPI:1649238619
Name:TALTS, KARL H (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:H
Last Name:TALTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8866
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27419-0866
Mailing Address - Country:US
Mailing Address - Phone:336-553-1659
Mailing Address - Fax:336-553-3994
Practice Address - Street 1:117 E KINGS HWY
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5201
Practice Address - Country:US
Practice Address - Phone:336-623-9711
Practice Address - Fax:336-553-3994
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050956207L00000X
NC9401065207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6905821Medicaid
VA5702259Medicaid
NC05821OtherBCBS
VA031831OtherANTHEM
VA031831OtherANTHEM
NC6905821Medicaid