Healthcare Provider Details

I. General information

NPI: 1285780049
Provider Name (Legal Business Name): A T TAMBOLI M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 E IRON AVE STE D
DOVER OH
44622-2097
US

IV. Provider business mailing address

PO BOX 3058
WHEELING WV
26003-0223
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-1205
  • Fax:
Mailing address:
  • Phone: 330-343-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35045162
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35063405
License Number StateOH

VIII. Authorized Official

Name: ARDESHIR TAMBOLI
Title or Position: OWNER
Credential:
Phone: 330-343-1205