Healthcare Provider Details

I. General information

NPI: 1215940390
Provider Name (Legal Business Name): LAWRENCE ELLIS TAMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 E MAIN ST WESTFIELD LAUREL HEALTH CENTER
WESTFIELD PA
16950-1607
US

IV. Provider business mailing address

22 WALNUT ST LAUREL HEALTH CENTER ADMINISTRATION ATTN:MARIA SMITH
WELLSBORO PA
16901-1526
US

V. Phone/Fax

Practice location:
  • Phone: 814-367-5911
  • Fax: 814-367-2791
Mailing address:
  • Phone: 570-723-0621
  • Fax: 570-724-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD040669L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: