Healthcare Provider Details

I. General information

NPI: 1639597347
Provider Name (Legal Business Name): HEATHER MCDONAGH TAMEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 FALLS RD STE 300
BALTIMORE MD
21209-2219
US

IV. Provider business mailing address

6115 FALLS RD STE 300
BALTIMORE MD
21209-2219
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-7611
  • Fax:
Mailing address:
  • Phone: 410-377-7611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number57331
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberD0089496
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: