MEDICARE: DR. TANCREDI F DAMORE MD

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	2086S0105X	Surgery of the Hand (Surgery) Physician	A51587	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	A51587	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00A515871	OTHER		PPIN

General Provider Information

NPI Number	:	1619958907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANCREDI F DAMORE MD

Provider Business Mailing Address
First Line	:	21 TAMAL VISTA BLVD
Second Line	:	SUITE 103
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1130
Country	:	US
Telephone Number	:	415-927-7660
Fax Number	:	415-927-7663

Provider Business Practice Location Address
First Line	:	21 TAMAL VISTA BLVD
Second Line	:	SUITE 103
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1130
Country	:	US
Telephone Number	:	415-927-7660
Fax Number	:	415-927-7663

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	05/23/2012

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Directions to “ DR. TANCREDI F DAMORE MD” Practice Location

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