Basic Information
| Provider Information | |||||||||
| NPI: | 1427175066 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAMURA | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | PSYCHOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 704 OLD LILESVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WADESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281702820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046946588 | ||||||||
| FaxNumber: | 7046946706 | ||||||||
| Practice Location | |||||||||
| Address1: | 704 OLD LILESVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WADESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281702820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046946588 | ||||||||
| FaxNumber: | 7046946706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 999 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1427175066 | 05 | NC | MEDICAID | 6107286 | 05 | NC | MEDICAID |