Provider Demographics
NPI:1386844603
Name:DAVIS, TAMMARA LEONE (MD)
Entity Type:Individual
Prefix:
First Name:TAMMARA
Middle Name:LEONE
Last Name:DAVIS
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 1:7474 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 730
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3504
Mailing Address - Country:US
Mailing Address - Phone:301-982-3437
Mailing Address - Fax:
Practice Address - Street 1:7474 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 730
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3504
Practice Address - Country:US
Practice Address - Phone:301-982-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD663382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD219496YAN8OtherPTAN