Provider Demographics
NPI:1194043208
Name:SMITH, TAMARA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:ANN
Last Name:SMITH
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 1:10570 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5242
Mailing Address - Country:US
Mailing Address - Phone:440-708-9853
Mailing Address - Fax:
Practice Address - Street 1:150 SEVENTH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-2908
Practice Address - Country:US
Practice Address - Phone:440-279-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-074385202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology