Provider Demographics
NPI:1013911486
Name:TAMBURELLO, TRACI A (DO)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:A
Last Name:TAMBURELLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:
Practice Address - Street 1:1098 STELTON RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5288
Practice Address - Country:US
Practice Address - Phone:732-572-5950
Practice Address - Fax:732-572-6384
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB07292000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH78951Medicare UPIN