Healthcare Provider Details

I. General information

NPI: 1982124244
Provider Name (Legal Business Name): TAMARA AISHAMARRYSHOW HUSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10562 LOVELAND MADEIRA RD
LOVELAND OH
45140-8962
US

IV. Provider business mailing address

10562 LOVELAND MADEIRA RD
LOVELAND OH
45140-8962
US

V. Phone/Fax

Practice location:
  • Phone: 513-583-6160
  • Fax: 513-583-6061
Mailing address:
  • Phone: 513-583-6160
  • Fax: 513-583-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLP04112
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number322666
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35143595
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: