Provider Demographics
NPI:1346204278
Name:ALEX, TAMMY (ND)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:ALEX
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2342
Mailing Address - Country:US
Mailing Address - Phone:203-389-0900
Mailing Address - Fax:
Practice Address - Street 1:11 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2342
Practice Address - Country:US
Practice Address - Phone:203-389-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00164208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice