Tackey, Edward O

Tackey, Edward O is an individual health care provider with primary practice located at 1930 Braeburn Cir , Salem VA 24153-7388. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Rheumatology. Allopathic & Osteopathic Physicians / Rheumatology is his primary health care specialty. Tackey, Edward O can be contacted via phone (540) 772-3707.

Contact Information

Primary practice address
1930 Braeburn Cir Salem VA 24153-7388
Phone: (540) 772-3707
Fax: (540) 772-3739
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X MD24622 Oregon
Allopathic & Osteopathic Physicians / Rheumatology 207RR0500X 0101243144 Virginia
Allopathic & Osteopathic Physicians / Rheumatology 207RR0500X C1-0023857 Delaware

Profile Details

NPI number 1669488110
LBN Legal business name Tackey, Edward O
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 1st, 2006
Last updated Aug 26th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669488110 NPPES
Virginia MEDICAID 1669488110
Virginia Other P00621111
Virginia MEDICAID 227217

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