Organization
ANTONIO TAMARA MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO TAMARA MD (OWNER)
(304) 264-1212
Entity
Organization
Contact information
Practice address
2500 HOSPITAL DRIVE, 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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009862
—
WV
01
—
DG3243
RAILROAD MEDICARE
—
Enumeration date
03/08/2007
Last updated
06/05/2013
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