Provider Demographics
NPI:1144219056
Name:CONGDON, TAMARA W (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:W
Last Name:CONGDON
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 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
151693OtherUCARE
MN64767800Medicaid
43F35COOtherBLUE CROSS BLUE SHIELD
1027347OtherPREFERRED ONE
2114112OtherFIRST HEALTH PLAN
HP32991OtherHEALTH PARTNERS
0402865OtherMEDICA HEALTH PLANS
1285470OtherARAZ GROUP AMERICAS PPO
43F35COOtherBLUE CROSS BLUE SHIELD