Provider Demographics
NPI:1891794871
Name:BABB, TAMARA C (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:C
Last Name:BABB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LEIGH
Other - Last Name:CHEATHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 896206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6206
Mailing Address - Country:US
Mailing Address - Phone:252-244-1785
Mailing Address - Fax:252-244-2876
Practice Address - Street 1:620 FARMLIFE AVENUE
Practice Address - Street 2:
Practice Address - City:VANCEBORO
Practice Address - State:NC
Practice Address - Zip Code:28586-7673
Practice Address - Country:US
Practice Address - Phone:252-244-1785
Practice Address - Fax:252-244-2876
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201556207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134J7Medicaid
NC134J7OtherBCBSNC
NC134J7OtherBCBSNC
E11234Medicare UPIN