Provider Demographics
NPI:1306834247
Name:TAM, HENRY W (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:W
Last Name:TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:216 EDGEFIELD AVE NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3910
Mailing Address - Country:US
Mailing Address - Phone:803-648-4224
Mailing Address - Fax:803-641-7600
Practice Address - Street 1:216 EDGEFIELD AVE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3910
Practice Address - Country:US
Practice Address - Phone:803-648-4224
Practice Address - Fax:803-641-7600
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCSC12889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080029213OtherRAILROAD MEDICARE
SC128891Medicaid
SC0142590001OtherCHAMPUS
SCQ23600Medicare UPIN
SCQ23600Medicare PIN