Healthcare Provider Details

I. General information

NPI: 1184614331
Provider Name (Legal Business Name): TAMARA HANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD DEPARTMENT OF PATHOLOGY
GREENWICH CT
06830-4697
US

IV. Provider business mailing address

14 RIVERBEND RD
OLD LYME CT
06371
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3927
  • Fax:
Mailing address:
  • Phone: 860-434-6698
  • Fax: 860-434-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number216104
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: