Provider Demographics
NPI:1053372698
Name:GUICHARD, TAMARA (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:GUICHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 YELLOWSTONE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-9406
Mailing Address - Country:US
Mailing Address - Phone:212-991-9991
Mailing Address - Fax:
Practice Address - Street 1:6915 YELLOWSTONE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-9406
Practice Address - Country:US
Practice Address - Phone:212-991-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02571846Medicaid
NYI20120Medicare UPIN
NY736C1Medicare PIN