Individual
TAMARA I FATIANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
877 W FARIS RD, SUITE D, GREENVILLE, SC 29605-4254
(864) 455-8001
(864) 455-8800
Mailing address
7 INDEPENDENCE PT, SUITE 140, GREENVILLE, SC 29615-4566
(864) 797-6044
(864) 797-6195
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
23132
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231323
—
SC
01
—
4581701
CIGNA
SC
01
—
576007863063
BCBS OF SC
SC
01
—
7375503
AETNA
SC
01
—
P00163870
RR MEDICARE
SC
01
—
P00801300
RR MEDICARE
SC
Enumeration date
05/31/2006
Last updated
04/27/2010
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