Provider Demographics
NPI:1407546146
Name:GARY, TAMARA PATRESE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:PATRESE
Last Name:GARY
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 1:4511 23RD PKWY APT 301
Mailing Address - Street 2:
Mailing Address - City:HILLCREST HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4442
Mailing Address - Country:US
Mailing Address - Phone:202-967-7473
Mailing Address - Fax:
Practice Address - Street 1:4511 23RD PKWY APT 301
Practice Address - Street 2:
Practice Address - City:HILLCREST HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20748-4442
Practice Address - Country:US
Practice Address - Phone:202-967-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator