Provider Demographics
NPI:1134101751
Name:HAMAWI, TATIANA ANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:ANNA
Last Name:HAMAWI
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 1:111 ELM ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1967
Mailing Address - Country:US
Mailing Address - Phone:508-753-7700
Mailing Address - Fax:
Practice Address - Street 1:111 ELM ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1967
Practice Address - Country:US
Practice Address - Phone:508-753-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152836207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA691751OtherHARVARD PILGRIM
MA790850OtherTUFTS HEALTH PLAN
MA3188302Medicaid
MA8197992OtherCIGNA
MAJ19405OtherBLUE CROSS BLUE SHIELD
MA2670728OtherAETNA
MAA23778Medicare ID - Type Unspecified
MA2670728OtherAETNA