Provider Demographics
NPI:1356391940
Name:TAMADON, AFSHIN (MD)
Entity type:Individual
Prefix:DR
First Name:AFSHIN
Middle Name:
Last Name:TAMADON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:TAMADON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7217
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-7217
Mailing Address - Country:US
Mailing Address - Phone:910-362-1112
Mailing Address - Fax:910-362-1115
Practice Address - Street 1:1914 MEETING CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6631
Practice Address - Country:US
Practice Address - Phone:910-362-1112
Practice Address - Fax:910-362-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800403208100000X
SC27487208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC274875Medicaid
NC790287FMedicaid
NC2247694AMedicare PIN
SCG644748207Medicare PIN
G64474Medicare UPIN