Individual
DR. EDWARD O TACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1930 BRAEBURN CIR, SALEM, VA 24153-7388
(540) 772-3707
(540) 772-3739
Mailing address
260 BEISER BLVD, STE 201, DOVER, DE 19904-5773
(302) 678-7438
(866) 984-3197
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD24622
OR
207RR0500X
Rheumatology Physician
0101243144
VA
207RR0500X
Rheumatology Physician
Primary
C1-0023857
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669488110
—
VA
05
—
227217
—
OR
01
—
P00621111
MEDICARE RAILROAD
VA
Enumeration date
08/01/2006
Last updated
08/26/2020
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