Provider Demographics
NPI:1275924532
Name:KHARAZISHVILI, TAMARA
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:KHARAZISHVILI
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 1:10849 63RD AVE
Mailing Address - Street 2:APT 1B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1358
Mailing Address - Country:US
Mailing Address - Phone:646-684-9834
Mailing Address - Fax:
Practice Address - Street 1:10849 63RD AVE
Practice Address - Street 2:APT 1B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1358
Practice Address - Country:US
Practice Address - Phone:646-684-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program