Provider Demographics
NPI:1073560769
Name:REPASSY, TRISTA N (MD)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:N
Last Name:REPASSY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:190 N MAIN ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2057
Mailing Address - Country:US
Mailing Address - Phone:508-655-2555
Mailing Address - Fax:508-655-2596
Practice Address - Street 1:190 N MAIN ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2057
Practice Address - Country:US
Practice Address - Phone:508-655-2555
Practice Address - Fax:508-655-2596
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2012-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA216066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9773894Medicaid
MAH72885Medicare UPIN
MA9773894Medicaid