Provider Demographics
NPI:1245397454
Name:ROYAL, TAMMULA C
Entity Type:Individual
Prefix:
First Name:TAMMULA
Middle Name:C
Last Name:ROYAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3266 OAK STREET EXT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-4619
Mailing Address - Country:US
Mailing Address - Phone:330-743-0730
Mailing Address - Fax:
Practice Address - Street 1:3266 OAK STREET EXT
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-4619
Practice Address - Country:US
Practice Address - Phone:330-743-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2409021Medicare UPIN