Provider Demographics
NPI:1023098639
Name:DURHAM-BORING, TAMMY N (DO)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:N
Last Name:DURHAM-BORING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9894 E 121ST ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037
Practice Address - Country:US
Practice Address - Phone:317-621-6060
Practice Address - Fax:317-355-6965
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002205A207R00000X, 207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01424312OtherRR MEDICARE
000000714181OtherANTHEM
IN200266500Medicaid
IN266180429Medicare PIN
INP01424312OtherRR MEDICARE
H09680Medicare UPIN