Provider Demographics
NPI:1821022344
Name:TAMESIS, MARION EUNICE BERBANO (MD)
Entity type:Individual
Prefix:
First Name:MARION EUNICE
Middle Name:BERBANO
Last Name:TAMESIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARION EUNICE
Other - Middle Name:BERBANO
Other - Last Name:TAMESIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:302 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1308
Mailing Address - Country:US
Mailing Address - Phone:607-444-5446
Mailing Address - Fax:607-444-5447
Practice Address - Street 1:302 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1308
Practice Address - Country:US
Practice Address - Phone:607-444-5446
Practice Address - Fax:607-444-5447
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437262208000000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023809860001Medicaid
COI34274OtherUPIN
NY02667729Medicaid
COBT9343625OtherDEA