Provider Demographics
NPI:1740247725
Name:TAMBOLI, JASMIN A (MD)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:A
Last Name:TAMBOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-723-1810
Mailing Address - Fax:304-723-5741
Practice Address - Street 1:227 CANTON RD
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953
Practice Address - Country:US
Practice Address - Phone:740-266-2161
Practice Address - Fax:304-723-5741
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063405207Q00000X
WV16914207Q00000X
PAMD044241E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0895152Medicaid
5630314OtherBCBS
E29930Medicare UPIN
0724662Medicare ID - Type Unspecified