Provider Demographics
NPI:1821022344
Name:TAMESIS, MARION EUNICE BERBANO (MD)
Entity Type:Individual
Prefix:
First Name:MARION EUNICE
Middle Name:BERBANO
Last Name:TAMESIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARION EUNICE
Other - Middle Name:BERBANO
Other - Last Name:TAMESIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:105 DESMOND ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2001
Practice Address - Country:US
Practice Address - Phone:570-887-2832
Practice Address - Fax:570-887-3035
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437262208000000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COI34274OtherUPIN
PA1023809860001Medicaid
NY02667729Medicaid
COBT9343625OtherDEA