1386638740 NPI number — DR. TAMARA R PRINGLE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386638740 NPI number — DR. TAMARA R PRINGLE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PRINGLE

Provider First Name:

TAMARA

Provider Middle Name:

R

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1386638740

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/09/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 749112

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ATLANTA

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30374-9112

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

434-245-1000

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2955 IVY RD STE 304

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CHARLOTTESVILLE

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

22903-9353

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

434-243-4570

Provider Business Practice Location Address Fax Number:

434-295-5491

Provider Enumeration Date:

08/31/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  0101238415 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0000254222203 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
• Identifier: 10002838 . This is a "OPTIMA HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 010242169 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 410214 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 60218 . This is a "CARENET" identifier . This identifiers is of the category "OTHER".
• Identifier: 7467784 . This is a "AETNA USHEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 1024169 . This is a "VA PREMIER" identifier . This identifiers is of the category "OTHER".
• Identifier: C09633 . This is a "GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 10002838 . This is a "SENTARA" identifier . This identifiers is of the category "OTHER".
• Identifier: 181293 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 2137971 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 1372520 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 541941044002 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".