Provider Demographics
NPI:1609961986
Name:ROOS, TAMMI C (MD)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:C
Last Name:ROOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMMI
Other - Middle Name:C
Other - Last Name:KOCHENAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0478
Mailing Address - Country:US
Mailing Address - Phone:910-296-2728
Mailing Address - Fax:910-296-2958
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-8801
Practice Address - Country:US
Practice Address - Phone:910-296-2728
Practice Address - Fax:910-296-2958
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00598207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02785028Medicaid
NYI49452Medicare UPIN
NY02785028Medicaid