Provider Demographics
NPI:1952795619
Name:RICHARDSON, TAMARA NICOLE (DO)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:NICOLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1859
Mailing Address - Country:US
Mailing Address - Phone:516-572-0159
Mailing Address - Fax:
Practice Address - Street 1:43 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8206
Practice Address - Country:US
Practice Address - Phone:718-992-2128
Practice Address - Fax:718-588-2045
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine