Provider Demographics
NPI:1528160215
Name:TAMAYO, LUTHER ROGAN (MD)
Entity type:Individual
Prefix:DR
First Name:LUTHER
Middle Name:ROGAN
Last Name:TAMAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRYAN MEADOW PATH
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2603
Mailing Address - Country:US
Mailing Address - Phone:631-757-0995
Mailing Address - Fax:
Practice Address - Street 1:4 BRYAN MEADOW PATH
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2603
Practice Address - Country:US
Practice Address - Phone:631-757-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF37167Medicare UPIN