Provider Demographics
NPI:1851556328
Name:VAN DINE, TAMMY L (DPM)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:VAN DINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3545
Mailing Address - Country:US
Mailing Address - Phone:401-354-7966
Mailing Address - Fax:401-941-0315
Practice Address - Street 1:1087 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3545
Practice Address - Country:US
Practice Address - Phone:401-354-7966
Practice Address - Fax:401-941-0315
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILPR00076213E00000X
RIDPM00331213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist