Provider Demographics
NPI:1932161742
Name:TAHTAWI, JORJETA D (MD)
Entity type:Individual
Prefix:
First Name:JORJETA
Middle Name:D
Last Name:TAHTAWI
Suffix:
Gender:F
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 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:50 DOCTORS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-7209
Practice Address - Country:US
Practice Address - Phone:828-684-2587
Practice Address - Fax:828-651-8344
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216192207R00000X
NC200801391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA696898OtherHARVARD PILGRIM
NCP01320169OtherMEDICARE RR
MAJ26039OtherBLUE CROSS
NC18317OtherBCBSNC
MAJ26039OtherBLUE CROSS
H82336Medicare UPIN
MA696898OtherHARVARD PILGRIM
MA2008840Medicaid