Provider Demographics
NPI:1962638254
Name:ZACH, TAMARA (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:ZACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22044 N 44TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-6104
Mailing Address - Country:US
Mailing Address - Phone:623-257-7673
Mailing Address - Fax:602-865-4507
Practice Address - Street 1:22044 N 44TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-6104
Practice Address - Country:US
Practice Address - Phone:623-257-7673
Practice Address - Fax:623-257-7344
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ443932080P0008X, 2084N0402X
NY2524792080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ613961Medicaid
AZ613961Medicaid
AZZ146371Medicare PIN