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General NPI Number Information
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NPI Number | 1881781003
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Entity Type | Organization
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Legal Business Name | DOMINIC W TAM MD & ROSE CW TAM MD INC
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Dates
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Enumeration Date | 10/08/2006
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 16000 PEARL RD
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City | STRONGSVILLE
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State | OH
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Zip | 44136-6082
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Country | US
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Telephone | 440-572-3020
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Fax | 216-765-8401
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Provider Business Mailing Address
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Address Line | 50 W JUNIPER LN
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City | MORELAND HILLS
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State | OH
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Zip | 44022-1380
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Country | US
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Telephone | 216-765-8402
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Fax | 216-765-8401
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSE CHUN WAH TAM
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Credential | M.D.
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Telephone | 216-765-8402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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