Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 15008 | MS |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 49422 | MA |
NPI | 1265434229 |
---|---|
Provider Name | Thom A. Tarquinio |
First Address | Worcester, MA 01605-2038 |
Second Address | Worcester, MA 01608-1216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 23/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117289 | (05) | MS |
200000249 | MEDICARE ID NOVARTIS SOLUTIONS (01) | MS |
200025582 | RAILROAD MEDICARE (01) | MS |
512G700003 | UP MEDICARE (01) | MS |
512I200010 | UP MEDICARE PTAN (01) | MS |
A68066 | (02) | MS |
P00462327 | RAILROAD MEDICARE PTAN (01) | MS |