Provider Demographics
NPI:1447430970
Name:CHARLES TAM MEDICAL CORPORATION
Entity type:Organization
Organization Name:CHARLES TAM MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T C
Authorized Official - Last Name:TAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-328-9500
Mailing Address - Street 1:2520 L ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2337
Mailing Address - Country:US
Mailing Address - Phone:661-328-9500
Mailing Address - Fax:661-328-0938
Practice Address - Street 1:2520 L ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2337
Practice Address - Country:US
Practice Address - Phone:661-328-9500
Practice Address - Fax:661-328-0938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19706207RC0000X, 207RI0011X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ48366ZMedicaid
CAZZZ48366ZMedicaid
CA=========OtherTAX I.D.
CAZZZ48366ZMedicare PIN