Healthcare Provider Details

I. General information

NPI: 1922018605
Provider Name (Legal Business Name): TAMARA LEA MUSGRAVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 ISLAND RD
BRISTOL VA
24201-7009
US

IV. Provider business mailing address

349 ISLAND RD
BRISTOL VA
24201-7009
US

V. Phone/Fax

Practice location:
  • Phone: 276-469-4200
  • Fax: 276-469-4249
Mailing address:
  • Phone: 276-469-4200
  • Fax: 276-469-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number32715
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number17425
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101261405
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number17425
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101261405
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number17425
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32715
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101261405
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number32715
License Number StateKY
# 10
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101261405
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: