Provider Demographics
NPI:1912915323
Name:LEDBETTER, TAMAR CHRISTINE (MD, MFT)
Entity Type:Individual
Prefix:DR
First Name:TAMAR
Middle Name:CHRISTINE
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:MD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BUGLE CT
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3345
Mailing Address - Country:US
Mailing Address - Phone:757-867-8707
Mailing Address - Fax:757-838-8233
Practice Address - Street 1:576 JEFFERSON AVE BLDG 576
Practice Address - Street 2:
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-1373
Practice Address - Country:US
Practice Address - Phone:757-314-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006709796Medicaid