Provider Demographics
NPI:1548232192
Name:MCBRIDE, TAMMY L (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:L
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2030 THISTLE HILL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRING GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17362-1159
Mailing Address - Country:US
Mailing Address - Phone:717-225-9869
Mailing Address - Fax:717-225-6552
Practice Address - Street 1:2030 THISTLE HILL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRING GROVE
Practice Address - State:PA
Practice Address - Zip Code:17362-1159
Practice Address - Country:US
Practice Address - Phone:717-225-9869
Practice Address - Fax:717-225-6552
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010705L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001899137Medicaid
PA058526ZEA5Medicare PIN
PA001899137Medicaid