Basic Information
| Provider Information | |||||||||
| NPI: | 1003896994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMAN | ||||||||
| FirstName: | TAMRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 MACCORKLE AVE SE STE 205 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047207305 | ||||||||
| FaxNumber: | 3047207310 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 MACCORKLE AVE SE STE 205 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047207305 | ||||||||
| FaxNumber: | 3047207310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2023 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | PO1065168 | 01 | WV | RR MEDICARE | OTHER | 1003896994 | 01 | WV | HIGHMARK WV | OTHER | 3810003271 | 05 | WV | MEDICAID | 00251341 | 01 | WV | RR MEDICARE | OTHER |