Provider Demographics
NPI:1952492548
Name:HOUSMAN, TAMARA S (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:HOUSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3811 ED DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8106
Mailing Address - Country:US
Mailing Address - Phone:919-390-0200
Mailing Address - Fax:919-390-0219
Practice Address - Street 1:3811 ED DR.
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8106
Practice Address - Country:US
Practice Address - Phone:919-390-0200
Practice Address - Fax:919-390-0219
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD27163207N00000X, 207ND0101X
NC200001428207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00443443OtherRR MEDICARE
ORP00443443OtherRR MEDICARE