1861457251 NPI number — TAMMI LOUISE SHLOTZHAUER M.D.

Table of content: ERICA J HOYER APN (NPI 1104259894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861457251 NPI number — TAMMI LOUISE SHLOTZHAUER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHLOTZHAUER
Provider First Name:
TAMMI
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861457251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 HELENDALE RD
Provider Second Line Business Mailing Address:
SUITE 90
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14609-3173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-288-0530
Provider Business Mailing Address Fax Number:
585-288-3363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 HELENDALE RD
Provider Second Line Business Practice Location Address:
SUITE 90
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14609-3173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-288-0530
Provider Business Practice Location Address Fax Number:
585-288-3363
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  167996 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P010167996 . This is a "EXCELLUS PROVIDER NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 167996 . This is a "NY STATE LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01264566 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101160CD . This is a "PREFERRED CARE NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010167996 . This is a "BLUE CROSS/BLUE SHIELD NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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