Provider Demographics
NPI:1225455686
Name:BININASHVILI, TAMARA (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:BININASHVILI
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 1:875 OAK ST SE STE 4030
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3984
Mailing Address - Country:US
Mailing Address - Phone:503-561-6444
Mailing Address - Fax:503-561-6440
Practice Address - Street 1:3025 RYAN DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5057
Practice Address - Country:US
Practice Address - Phone:503-540-9999
Practice Address - Fax:503-540-3105
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD192737207RI0200X
CAA147439207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty