Provider Demographics
NPI:1225391303
Name:SMITH, TAMARA (MED)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DREISER LOOP
Mailing Address - Street 2:#3B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2602
Mailing Address - Country:US
Mailing Address - Phone:917-913-6945
Mailing Address - Fax:
Practice Address - Street 1:120 DREISER LOOP
Practice Address - Street 2:#3B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2602
Practice Address - Country:US
Practice Address - Phone:917-913-6945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist