Provider Demographics
NPI:1306874136
Name:PRICE, TAMARA L W (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:L W
Last Name:PRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:400 ROUSER RD
Mailing Address - Street 2:BUILDING 2, SUITE 102
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2842
Mailing Address - Country:US
Mailing Address - Phone:412-299-5540
Mailing Address - Fax:412-299-5542
Practice Address - Street 1:631 N BROAD STREET EXT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4603
Practice Address - Country:US
Practice Address - Phone:724-450-7246
Practice Address - Fax:724-450-7247
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048296L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF89468Medicare UPIN
PA528200Medicare ID - Type Unspecified