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1134182843

NPI Code Detail

MEDICARE: TAMI SUE MARRIOTT MD

MEDICARE: TAMI SUE MARRIOTT 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
1	207P00000X	Emergency Medicine Physician	MD27684	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000038219	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1134182843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMI SUE MARRIOTT MD

Provider Business Mailing Address
First Line	:	2100 POWELL ST
Second Line	:	STE 900
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-1844
Country	:	US
Telephone Number	:	510-851-7423
Fax Number	:	510-879-9120

Provider Business Practice Location Address
First Line	:	2700 NW STEWART PKWY
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-1281
Country	:	US
Telephone Number	:	541-677-4333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	02/25/2017

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Directions to “ TAMI SUE MARRIOTT MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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