Basic Information
| Provider Information | |||||||||
| NPI: | 1982605895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIN | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 EASTOWNE DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199668279 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1824 PISGAH DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286948427 | ||||||||
| FaxNumber: | 8286948428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200401622 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5902136 | 05 | NC | MEDICAID | NCT970B | 01 | NC | MEDICARE PIN | OTHER |