Provider Demographics
NPI:1174501027
Name:GAMMADA, EPHRAIM B (MD, INTERNAL MEDICIN)
Entity Type:Individual
Prefix:DR
First Name:EPHRAIM
Middle Name:B
Last Name:GAMMADA
Suffix:
Gender:M
Credentials:MD, INTERNAL MEDICIN
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Other - First Name:
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Mailing Address - Street 1:1509 OLD COWAN RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-1913
Mailing Address - Country:US
Mailing Address - Phone:931-962-2540
Mailing Address - Fax:931-962-1400
Practice Address - Street 1:1509 OLD COWAN RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-1913
Practice Address - Country:US
Practice Address - Phone:931-962-2540
Practice Address - Fax:931-962-1400
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000026560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG07420Medicare UPIN
TN3093481Medicare ID - Type Unspecified