Provider Demographics
NPI:1144202250
Name:DENSMORE, TAMARA L (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:DENSMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:446 TAMIAMI TRL S
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2625
Mailing Address - Country:US
Mailing Address - Phone:941-483-3319
Mailing Address - Fax:941-483-3406
Practice Address - Street 1:446 TAMIAMI TRL S
Practice Address - Street 2:2ND FLOOR
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2625
Practice Address - Country:US
Practice Address - Phone:941-483-3319
Practice Address - Fax:941-483-3406
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75341207ZC0500X, 207ZP0102X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25603480Medicaid
FL25603480Medicaid
FL44621ZMedicare ID - Type Unspecified