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NPI Code Detail

MEDICARE: ANTONIO TAMARA MD

MEDICARE: ANTONIO TAMARA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician11343WV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1110027353OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043213655
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONIO TAMARA MD
Provider Business Mailing Address
First Line : PO BOX 489
Second Line :
City : BLUEFIELD
State : WV
Zip : 24701-0489
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 HOSPITAL DRIVE
Second Line : CITY HOSPITAL
City : MARTINSBURG
State : WV
Zip : 25401-3402
Country : US
Telephone Number : 304-264-1212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 06/05/2013

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Directions to “ ANTONIO TAMARA MD” Practice Location

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