Provider Demographics
NPI:1336866763
Name:TAMBI MEDICAL LLC
Entity Type:Organization
Organization Name:TAMBI MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:INNOCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MONYA-TAMBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-370-5348
Mailing Address - Street 1:2890 ORDWAY DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1038
Mailing Address - Country:US
Mailing Address - Phone:443-370-5348
Mailing Address - Fax:443-855-6394
Practice Address - Street 1:30 S QUAKER LN STE 201
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4596
Practice Address - Country:US
Practice Address - Phone:443-370-5348
Practice Address - Fax:443-855-6394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care