Healthcare Provider Details

I. General information

NPI: 1740247725
Provider Name (Legal Business Name): JASMIN A TAMBOLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CANTON RD
WINTERSVILLE OH
43953
US

IV. Provider business mailing address

2814 PENNSYLVANIA AVE
WEIRTON WV
26062
US

V. Phone/Fax

Practice location:
  • Phone: 740-266-2161
  • Fax: 304-723-5741
Mailing address:
  • Phone: 304-723-1810
  • Fax: 304-723-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35063405
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16914
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD044241E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: