Provider Demographics
NPI:1457882490
Name:THOMAS, TAMARA L
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:NORTHEAST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04662-0060
Mailing Address - Country:US
Mailing Address - Phone:207-664-8692
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1919
Practice Address - Country:US
Practice Address - Phone:844-934-6243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH442292085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound