MEDICARE: DR. TAMMER N GHALY 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	207L00000X	Anesthesiology Physician	2025050718	MO
2	207L00000X	Anesthesiology Physician	68631	CT
3	207L00000X	Anesthesiology Physician	32595	NE

General Provider Information

NPI Number	:	1437543527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMER N GHALY MD

Provider Business Mailing Address
First Line	:	267 GRANT ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-2870
Country	:	US
Telephone Number	:	203-384-3000
Fax Number	:	203-384-4749

Provider Business Practice Location Address
First Line	:	1 HOSPITAL DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65212-0001
Country	:	US
Telephone Number	:	573-882-2568
Fax Number	:	855-903-0985

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	12/01/2025

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