Provider Demographics
NPI:1396460127
Name:RICHMOND, TAMARA ELIZABETH
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ELIZABETH
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SILSBY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2911
Mailing Address - Country:US
Mailing Address - Phone:216-280-8434
Mailing Address - Fax:
Practice Address - Street 1:3301 SILSBY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2911
Practice Address - Country:US
Practice Address - Phone:216-280-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP938123172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver