Provider Demographics
NPI:1881781003
Name:DOMINIC W TAM MD & ROSE CW TAM MD INC
Entity type:Organization
Organization Name:DOMINIC W TAM MD & ROSE CW TAM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:CHUN WAH
Authorized Official - Last Name:TAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-765-8402
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty