Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | A51587 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | A51587 | CA |
NPI | 1619958907 |
---|---|
Provider Name | Dr. Tancredi F Damore |
First Address | Corte Madera, CA 94925-1130 |
Second Address | Corte Madera, CA 94925-1130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 23/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A515871 | (05) | CA |
00A515871 | PPIN (01) | |
E81336 | (02) |