Healthcare Provider Details

I. General information

NPI: 1265756753
Provider Name (Legal Business Name): STUTI TAMBAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 PARK CLUB LN STE 120
WILLIAMSVILLE NY
14221-5270
US

IV. Provider business mailing address

PO BOX 488
BUFFALO NY
14240-0488
US

V. Phone/Fax

Practice location:
  • Phone: 716-422-0010
  • Fax:
Mailing address:
  • Phone: 866-853-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number152140
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number303976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: