MEDICARE: INDRA TAMBAR 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	207Q00000X	Family Medicine Physician	1472781	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000500973001	OTHER	NY	BLUE CROSS
2	00010177201	OTHER	NY	UNIVERA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992771794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDRA TAMBAR MD

Provider Business Mailing Address
First Line	:	415 TREMONT ST
Second Line	:	SUITE 3
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-690-2367
Fax Number	:	716-690-2419

Provider Business Practice Location Address
First Line	:	415 TREMONT ST
Second Line	:	SUITE 3, 2ND FLOOR
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-690-2367
Fax Number	:	716-690-2419

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	09/24/2014

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Directions to “ INDRA TAMBAR MD” Practice Location

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