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 1:932 S HIGHWAY 123 BYP
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-9756
Mailing Address - Country:US
Mailing Address - Phone:830-379-3999
Mailing Address - Fax:830-379-3990
Practice Address - Street 1:932 S HIGHWAY 123 BYP
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-9756
Practice Address - Country:US
Practice Address - Phone:830-379-3999
Practice Address - Fax:830-379-3990
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2024-01-05
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
TX039233408Medicaid
TX039233407Medicaid
TXTXB113388OtherPTAN
TX031410601Medicaid
TX336698YLP1Medicare PIN
TX00922GMedicare ID - Type Unspecified
TX039233407Medicaid