Provider Demographics
NPI:1023192994
Name:STALL, TAMRA (MD)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:STALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-1055
Mailing Address - Fax:
Practice Address - Street 1:106 PARK DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:24445-2921
Practice Address - Country:US
Practice Address - Phone:540-839-7000
Practice Address - Fax:540-839-7172
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101256128OtherSTATE LICENSE
E61349Medicare ID - Type Unspecified
NC8979194Medicare ID - Type Unspecified