MEDICARE: DR. TAMARA BENYASHVILI M.D.

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	207RI0008X	Hepatology Physician	036.135063	IL
2	207R00000X	Internal Medicine Physician	279657	NY
3	207R00000X	Internal Medicine Physician	0101259282	VA

General Provider Information

NPI Number	:	1548554074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMARA BENYASHVILI M.D.

Provider Business Mailing Address
First Line	:	9 W 31ST ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-4474
Country	:	US
Telephone Number	:	212-203-8849
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 W 31ST ST
Second Line	:	9B
City	:	NEW YORK
State	:	NY
Zip	:	10001-4474
Country	:	US
Telephone Number	:	212-203-8849
Fax Number	:

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

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	12/16/2015

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