Provider Demographics
NPI:1770572570
Name:TSAHAKIS, PAUL J (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:TSAHAKIS
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-544-6920
Mailing Address - Fax:704-316-3061
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3174
Practice Address - Country:US
Practice Address - Phone:704-544-6920
Practice Address - Fax:704-316-3061
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40007207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8983852Medicaid
SCN40007Medicaid
NC8983852Medicaid
NC2156266JMedicare PIN
SCN40007Medicaid