Provider Demographics
NPI:1184070906
Name:TAMMINGA, KYLE SCOTT (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:SCOTT
Last Name:TAMMINGA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7011 FAYETTEVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7745
Practice Address - Country:US
Practice Address - Phone:919-361-2644
Practice Address - Fax:919-484-0849
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2023-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2019-01453207Q00000X
NC218429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine