Provider Demographics
NPI:1871688200
Name:MARTIN, TAMELA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:TAMELA
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMELA
Other - Middle Name:ANN
Other - Last Name:MONTELEONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1060 COUNTY ROAD 367
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-2123
Mailing Address - Country:US
Mailing Address - Phone:256-275-3494
Mailing Address - Fax:256-275-3397
Practice Address - Street 1:3115 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-2546
Practice Address - Country:US
Practice Address - Phone:256-275-3494
Practice Address - Fax:256-275-3397
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD42672207W00000X
CAG77469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G47349Medicare UPIN
CACH051AMedicare PIN