Edward Gale Loy Tautjo, MD
Hospitalist in Charlotte, NC. Individual provider (NPI-1).
NPI number1790786283
StatusActive
Last updated in NPPESFeb 8, 2023
Details
- NPI
- 1790786283
- Entity type
- Individual (NPI-1)
- Name
- Edward Gale Loy Tautjo
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 9, 2005
- Certification date
- Feb 8, 2023
- Last updated
- Feb 8, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208M00000X | Hospitalist | 9701614 | NC | Yes |
| 207R00000X | Internal Medicine | 009701614 | NC |
Practice location
200 Hawthorne LnCharlotte, NC 28204-2515
Phone 704-384-5416 · Fax 704-384-5992
Mailing address
Po Box 60447Charlotte, NC 28260-0447
Phone 704-384-5416 · Fax 704-384-5992
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