Provider Demographics
NPI:1982634812
Name:CHANDLER, TAMARA K (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:K
Last Name:CHANDLER
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 1:525 E MARKET ST
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-375-3588
Mailing Address - Fax:330-375-7615
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:SUITE 1N
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-3588
Practice Address - Fax:330-375-7615
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 094352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2996656Medicaid
OH4278631OtherMEDICARE ID
OH2996656Medicaid