MEDICARE: TAMARA I FATIANOV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	23132	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00163870	OTHER	SC	RR MEDICARE
3	P00801300	OTHER	SC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	576007863063	OTHER	SC	BCBS OF SC
4	7375503	OTHER	SC	AETNA
5	4581701	OTHER	SC	CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205873437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA I FATIANOV M.D.

Provider Business Mailing Address
First Line	:	7 INDEPENDENCE PT
Second Line	:	SUITE 140
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4566
Country	:	US
Telephone Number	:	864-797-6044
Fax Number	:	864-797-6195

Provider Business Practice Location Address
First Line	:	877 W FARIS RD
Second Line	:	SUITE D
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4254
Country	:	US
Telephone Number	:	864-455-8001
Fax Number	:	864-455-8800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	04/27/2010

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Directions to “ TAMARA I FATIANOV M.D.” Practice Location

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