Provider Demographics
NPI:1982124244
Name:HUSON, TAMARA AISHAMARRYSHOW (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:AISHAMARRYSHOW
Last Name:HUSON
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 1:10562 LOVELAND MADEIRA RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8962
Mailing Address - Country:US
Mailing Address - Phone:513-583-6160
Mailing Address - Fax:513-583-6061
Practice Address - Street 1:10562 LOVELAND MADEIRA RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8962
Practice Address - Country:US
Practice Address - Phone:513-583-6160
Practice Address - Fax:513-583-6061
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP04112207Q00000X
LA322666207Q00000X
OH35143595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILP04112OtherRHODE ISLAND MEDICAL LICENSE