Tammy Bostelman
Individual provider Active NPI Specialist · Edon, OH
NPI 1801210786 · NPPES record last updated Feb 12, 2014
Key facts
- NPI
- 1801210786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- DF1002221 (OH)
- Practice address
- 802 W Indiana St
Edon, OH 43518-9627 - Phone
- (419) 272-3213
- NPI assigned
- Feb 12, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DF1002221 | OH | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edon-Northwest Local SD | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | DF1002221 | OH | Yes |
Addresses
Primary practice location
802 W Indiana St
Edon, OH 43518-9627
Mailing address
802 W Indiana St
Edon, OH 43518-9627
Phone (419) 272-3213
Other providers in Edon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.