Provider Demographics
NPI:1609208370
Name:TAMMY TADOM MD PA
Entity Type:Organization
Organization Name:TAMMY TADOM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TADOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-898-1135
Mailing Address - Street 1:2614 E COLONIAL DR
Mailing Address - Street 2:SUITE 400-5
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5028
Mailing Address - Country:US
Mailing Address - Phone:407-897-1135
Mailing Address - Fax:407-897-1136
Practice Address - Street 1:2614 E COLONIAL DR
Practice Address - Street 2:SUITE 400-5
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5028
Practice Address - Country:US
Practice Address - Phone:407-897-1135
Practice Address - Fax:407-897-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78176261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service