Provider Demographics
NPI:1821193293
Name:KINCADE, TAMARA K (MD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:K
Last Name:KINCADE
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 1:102 15TH ST NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1616
Mailing Address - Country:US
Mailing Address - Phone:276-679-1623
Mailing Address - Fax:276-679-6811
Practice Address - Street 1:102 15TH ST NW
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1616
Practice Address - Country:US
Practice Address - Phone:276-679-1623
Practice Address - Fax:276-679-6811
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057677207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70260Medicare UPIN
003667C27Medicare ID - Type Unspecified