Provider Demographics
NPI:1588625735
Name:TAMTAM, SANKARARAO (MD)
Entity type:Individual
Prefix:DR
First Name:SANKARARAO
Middle Name:
Last Name:TAMTAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:830-730-5025
Mailing Address - Fax:830-730-4207
Practice Address - Street 1:1770 STATE HIGHWAY 46 W STE 1201
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5393
Practice Address - Country:US
Practice Address - Phone:830-730-4125
Practice Address - Fax:830-312-7896
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031410601Medicaid
TX039233411Medicaid
TX039233415Medicaid
TX039233407Medicaid
TX039233408Medicaid
TX336698YLP1Medicare PIN
TX00922GMedicare ID - Type Unspecified
TX039233407Medicaid