Provider Demographics
NPI:1497724686
Name:SPEAR, TAMMY ROSE (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ROSE
Last Name:SPEAR
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:PO BOX 620658
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0110
Mailing Address - Country:US
Mailing Address - Phone:336-716-2011
Mailing Address - Fax:
Practice Address - Street 1:1007-G HIGHWAY 150 WEST
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9772
Practice Address - Country:US
Practice Address - Phone:336-644-7771
Practice Address - Fax:336-644-6118
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCJ958AMedicare PIN
NC4991234OtherCIGNA
NC2229948BMedicare PIN
NC35501OtherSECURE HORIZONS
NCG32862Medicare UPIN
NC5393219OtherAETNA
NC8978613Medicaid
NC2073987OtherFIRST HEALTH/CCN
NC437452OtherWELLPATH
NC78613OtherBLUE CROSS BLUE SHIELD NC