Provider Demographics
NPI:1619958907
Name:DAMORE, TANCREDI F (MD)
Entity Type:Individual
Prefix:DR
First Name:TANCREDI
Middle Name:F
Last Name:DAMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:21 TAMAL VISTA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1130
Mailing Address - Country:US
Mailing Address - Phone:415-927-7660
Mailing Address - Fax:415-927-7663
Practice Address - Street 1:21 TAMAL VISTA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1130
Practice Address - Country:US
Practice Address - Phone:415-927-7660
Practice Address - Fax:415-927-7663
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA515872086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A515871Medicaid
00A515871OtherPPIN
00A515871OtherPPIN
CAZZZ32083ZMedicare PIN