Provider Demographics
NPI:1083792253
Name:TAMBAR, PREM KRISHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PREM
Middle Name:KRISHAN
Last Name:TAMBAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:151 BUFFALO AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14303-1243
Mailing Address - Country:US
Mailing Address - Phone:716-282-3310
Mailing Address - Fax:716-282-3346
Practice Address - Street 1:151 BUFFALO AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14303-1243
Practice Address - Country:US
Practice Address - Phone:716-282-3310
Practice Address - Fax:716-282-3346
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2014-09-29
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Provider Licenses
StateLicense IDTaxonomies
NY144911207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB35567Medicare UPIN