Provider Demographics
NPI:1992771794
Name:TAMBAR, INDRA (MD)
Entity type:Individual
Prefix:
First Name:INDRA
Middle Name:
Last Name:TAMBAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 TREMONT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-6135
Mailing Address - Country:US
Mailing Address - Phone:716-690-2367
Mailing Address - Fax:716-690-2419
Practice Address - Street 1:415 TREMONT ST
Practice Address - Street 2:SUITE 3, 2ND FLOOR
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6135
Practice Address - Country:US
Practice Address - Phone:716-690-2367
Practice Address - Fax:716-690-2419
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1472781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000500973001OtherBLUE CROSS
NY00010177201OtherUNIVERA
NY00686939Medicaid
NY00010177201OtherUNIVERA
NY009731Medicare PIN