Individual
ANTONIO TAMARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 HOSPITAL DRIVE, CITY HOSPITAL, MARTINSBURG, WV 25401-3402
(304) 264-1212
Mailing address
PO BOX 489, BLUEFIELD, WV 24701-0489
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
11343
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101794000
—
WV
01
—
110027353
RAILROAD MEDICARE
—
Enumeration date
05/27/2005
Last updated
06/05/2013
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