Provider Demographics
NPI:1053359364
Name:TATA, JOHN ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:TATA
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 1:125 WAMSUTTA MILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5522
Mailing Address - Country:US
Mailing Address - Phone:828-430-3511
Mailing Address - Fax:336-464-2907
Practice Address - Street 1:125 WAMSUTTA MILL RD STE B
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5522
Practice Address - Country:US
Practice Address - Phone:828-430-3511
Practice Address - Fax:336-464-2907
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA420432085R0202X
NC2004009852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053359364Medicaid