Provider Demographics
NPI:1407077357
Name:MCBRIDE, TAMY D
Entity Type:Individual
Prefix:
First Name:TAMY
Middle Name:D
Last Name:MCBRIDE
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 1:4886 WESTCHESTER DR
Mailing Address - Street 2:APT #4
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515
Mailing Address - Country:US
Mailing Address - Phone:330-507-0278
Mailing Address - Fax:
Practice Address - Street 1:3631 DOVER RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511
Practice Address - Country:US
Practice Address - Phone:330-782-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2499667OtherPROVIDER NUMBER CARE STAR