Provider Demographics
NPI:1114971694
Name:TEMPLE, TAI (MD)
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1739
Mailing Address - Country:US
Mailing Address - Phone:508-881-6708
Mailing Address - Fax:508-881-6708
Practice Address - Street 1:100 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4051
Practice Address - Country:US
Practice Address - Phone:508-765-9771
Practice Address - Fax:508-909-7735
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4097265OtherBLUE CROSS
TNP00211999OtherRAILROAD MEDICARE
TNI16716Medicare UPIN
TNP00211999OtherRAILROAD MEDICARE
TN3897770Medicare ID - Type Unspecified