Provider Demographics
NPI:1265853709
Name:JEFFERIS, TAMAR V
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:V
Last Name:JEFFERIS
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 1:19 N. PROVIDENCE ROAD
Mailing Address - Street 2:BOX 267
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 N. PROVIDENCE ROAD
Practice Address - Street 2:BOX 267
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086
Practice Address - Country:US
Practice Address - Phone:610-909-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020098E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine