1205010428 NPI number — BRYANT A TARR DPM

Table of content: (NPI 1205010428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205010428 NPI number — BRYANT A TARR DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRYANT A TARR DPM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUDBURY PODIATRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205010428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 BOSTON POST RD
Provider Second Line Business Mailing Address:
STE108
Provider Business Mailing Address City Name:
SUDBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01776-2463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-443-4878
Provider Business Mailing Address Fax Number:
978-443-1470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 BOSTON POST RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SUDBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01776-2463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-443-4878
Provider Business Practice Location Address Fax Number:
978-443-1470
Provider Enumeration Date:
12/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TARR
Authorized Official First Name:
BRYANT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-443-4878

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  001971 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com