Provider Demographics
NPI:1003896994
Name:AMAN, TAMRA (DO)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:AMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE STE 205
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1228
Mailing Address - Country:US
Mailing Address - Phone:304-720-7305
Mailing Address - Fax:304-720-7310
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 205
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1228
Practice Address - Country:US
Practice Address - Phone:304-720-7305
Practice Address - Fax:304-720-7310
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPO1065168OtherRR MEDICARE
WV1003896994OtherHIGHMARK WV
WV3810003271Medicaid
WV00251341OtherRR MEDICARE
WV00251341OtherRR MEDICARE
WVPO1065168OtherRR MEDICARE
WV3810003271Medicaid