Healthcare Provider Details

I. General information

NPI: 1598792137
Provider Name (Legal Business Name): TAMARA STONE IORIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 VICKERS DR
COLUMBUS IN
47203-4649
US

IV. Provider business mailing address

4225 VICKERS DR
COLUMBUS IN
47203-4649
US

V. Phone/Fax

Practice location:
  • Phone: 812-379-9524
  • Fax: 812-376-6383
Mailing address:
  • Phone: 812-379-9524
  • Fax: 812-376-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1053570A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: