Provider Demographics
NPI:1255561452
Name:TAM, MATTHEW D (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 COVENTRY RD APT 19
Mailing Address - Street 2:CLEVELAND HEIGHTS
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1664
Mailing Address - Country:US
Mailing Address - Phone:216-276-0205
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC 9500 EUCLID AVE
Practice Address - Street 2:INTERVENTIONAL RADIOLOGY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program