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General NPI Number Information
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NPI Number | 1366766263
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Entity Type | Individual
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Provider Name | TAMA EVELYN GILLIS M.D.,MPH.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 1037 IRVING STREET NE
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City | WASHINGTON
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State | DC
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Zip | 20017-3419
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Country | US
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Telephone | 202-526-6830
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Fax | 202-526-6830
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Provider Business Mailing Address
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Address Line | 1037 IRVING ST NE 1037 IRVING STREET NE
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City | WASHINGTON
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State | DC
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Zip | 20017-3419
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Country | US
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Telephone | 202-526-6830
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Fax | 202-526-6830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 13456
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License Number State | DC
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