Basic Information
| Provider Information | |||||||||
| NPI: | 1649238619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TALTS | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8866 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274190866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365531659 | ||||||||
| FaxNumber: | 3365533994 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 E KINGS HWY | ||||||||
| Address2: | |||||||||
| City: | EDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272885201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366239711 | ||||||||
| FaxNumber: | 3365533994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 08/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101050956 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 9401065 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 6905821 | 05 | NC | MEDICAID | 5702259 | 05 | VA | MEDICAID | 05821 | 01 | NC | BCBS | OTHER | 031831 | 01 | VA | ANTHEM | OTHER |