Provider Demographics
NPI:1639185093
Name:BRAVERMAN, TAMAR RANON (MD)
Entity type:Individual
Prefix:DR
First Name:TAMAR
Middle Name:RANON
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2560 DIXWELL AVE
Mailing Address - Street 2:#2-B
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1851
Mailing Address - Country:US
Mailing Address - Phone:203-230-2546
Mailing Address - Fax:203-288-5059
Practice Address - Street 1:2560 DIXWELL AVE
Practice Address - Street 2:#2-B
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1851
Practice Address - Country:US
Practice Address - Phone:203-230-2546
Practice Address - Fax:203-288-5059
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1639185093Medicaid
CT1639185093Medicaid