Provider Demographics
NPI:1255973921
Name:ELSAS, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:ELSAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:NIKOLAEVNA
Other - Last Name:BOYARINOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3355 RICHMOND RD STE 225A
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4180
Mailing Address - Country:US
Mailing Address - Phone:216-831-1494
Mailing Address - Fax:216-831-9931
Practice Address - Street 1:3355 RICHMOND RD STE 225A
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4180
Practice Address - Country:US
Practice Address - Phone:216-831-1494
Practice Address - Fax:216-831-9931
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker