Provider Demographics
NPI:1457361586
Name:GILBERT, TAMELA G (MD)
Entity type:Individual
Prefix:
First Name:TAMELA
Middle Name:G
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3270 BLAZER PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2115
Mailing Address - Country:US
Mailing Address - Phone:859-264-1182
Mailing Address - Fax:859-263-1187
Practice Address - Street 1:3270 BLAZER PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2115
Practice Address - Country:US
Practice Address - Phone:859-264-1182
Practice Address - Fax:859-263-1187
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY280042084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64-080047Medicaid
KYF69986Medicare UPIN
KY0978903Medicare ID - Type Unspecified