Provider Demographics
NPI:1982845087
Name:BAVENDAM, TAMARA G (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:G
Last Name:BAVENDAM
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 1:235 E 42ND ST
Mailing Address - Street 2:235/4/46
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5703
Mailing Address - Country:US
Mailing Address - Phone:212-733-3936
Mailing Address - Fax:
Practice Address - Street 1:235 E 42ND ST
Practice Address - Street 2:235/4/46
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5703
Practice Address - Country:US
Practice Address - Phone:212-733-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061573L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology