Provider Demographics
NPI:1023019403
Name:MENARD, TAMI R (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:TAMI
Middle Name:R
Last Name:MENARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BALD HILL RD
Mailing Address - Street 2:SUITE 526
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1617
Mailing Address - Country:US
Mailing Address - Phone:401-738-4323
Mailing Address - Fax:401-738-3857
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:SUITE 526
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-738-4323
Practice Address - Fax:401-738-3857
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00439363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIQ06467Medicare UPIN