Provider Demographics
NPI:1700973724
Name:TAM, ROSE CHUN WAH (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:CHUN WAH
Last Name:TAM
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 1:50 W JUNIPER LN
Mailing Address - Street 2:
Mailing Address - City:MORELAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1380
Mailing Address - Country:US
Mailing Address - Phone:216-765-8402
Mailing Address - Fax:216-765-8401
Practice Address - Street 1:16000 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6082
Practice Address - Country:US
Practice Address - Phone:440-572-3020
Practice Address - Fax:216-765-8401
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35046017207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology