Healthcare Provider Details

I. General information

NPI: 1952492548
Provider Name (Legal Business Name): TAMARA S HOUSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 ED DR. SUITE 110
RALEIGH NC
27612-8106
US

IV. Provider business mailing address

3811 ED DRIVE SUITE 110
RALEIGH NC
27612-8106
US

V. Phone/Fax

Practice location:
  • Phone: 919-390-0200
  • Fax: 919-390-0219
Mailing address:
  • Phone: 919-390-0200
  • Fax: 919-390-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD27163
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number200001428
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD27163
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number200001428
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: