Provider Demographics
NPI:1083649842
Name:TAMLYN, TODD R (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:R
Last Name:TAMLYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9088
Mailing Address - Country:US
Mailing Address - Phone:419-483-2494
Mailing Address - Fax:
Practice Address - Street 1:102 COMMERCE PARK DR STE D
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9095
Practice Address - Country:US
Practice Address - Phone:419-483-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.066390208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2018828Medicaid
OHP00670341OtherRR MEDICARE
OHTA4185082Medicare PIN