Provider Demographics
NPI:1548554074
Name:BENYASHVILI, TAMARA (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:BENYASHVILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:IASHVILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4474
Mailing Address - Country:US
Mailing Address - Phone:212-203-8849
Mailing Address - Fax:
Practice Address - Street 1:9 W 31ST ST
Practice Address - Street 2:9B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4474
Practice Address - Country:US
Practice Address - Phone:212-203-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.135063207RI0008X
NY279657207R00000X
VA0101259282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology