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General NPI Number Information
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NPI Number | 1285780049
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Entity Type | Organization
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Legal Business Name | A T TAMBOLI M D INC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 899 E IRON AVE STE D
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City | DOVER
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State | OH
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Zip | 44622-2097
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Country | US
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Telephone | 330-343-1205
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3058
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City | WHEELING
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State | WV
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Zip | 26003-0223
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Country | US
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Telephone | 330-343-1205
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ARDESHIR TAMBOLI
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Credential |
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Telephone | 330-343-1205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35063405
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 35045162
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License Number State | OH
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