Provider Demographics
NPI:1285780049
Name:A T TAMBOLI M D INC
Entity type:Organization
Organization Name:A T TAMBOLI M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARDESHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-343-1205
Mailing Address - Street 1:PO BOX 3058
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0223
Mailing Address - Country:US
Mailing Address - Phone:330-343-1205
Mailing Address - Fax:
Practice Address - Street 1:899 E IRON AVE STE D
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2097
Practice Address - Country:US
Practice Address - Phone:330-343-1205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045162207K00000X
OH35063405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35063405OtherDR. JASMIN TAMBOLI
OH0433294Medicaid
OH0895152Medicaid
OH35045162OtherDR. ADIE TAMBOLI
OH0511962Medicare PIN
OH0433294Medicaid
OH0895152Medicaid
OH0724661Medicare ID - Type UnspecifiedDR. JASMIN TAMBOLI
OH35063405OtherDR. JASMIN TAMBOLI