Provider Demographics
NPI:1083339055
Name:MATTISON, TAMARA M (ARRT R MR)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:M
Last Name:MATTISON
Suffix:
Gender:F
Credentials:ARRT R MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 W CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3922
Mailing Address - Country:US
Mailing Address - Phone:302-765-8607
Mailing Address - Fax:
Practice Address - Street 1:2001 LINCOLN DR W STE D
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1531
Practice Address - Country:US
Practice Address - Phone:609-917-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver