Provider Demographics
NPI:1164599742
Name:JAMES F TIERNEY MD
Entity Type:Organization
Organization Name:JAMES F TIERNEY MD
Other - Org Name:CARITAS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD OWNER SOLO CORP LONG DISSOLVED
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:508-994-1990
Mailing Address - Street 1:26 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3417
Mailing Address - Country:US
Mailing Address - Phone:508-994-1990
Mailing Address - Fax:508-994-1990
Practice Address - Street 1:26 GROVE STREET
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3417
Practice Address - Country:US
Practice Address - Phone:508-994-1990
Practice Address - Fax:508-994-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26243208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0187968Medicaid
B98497Medicare UPIN
MA0187968Medicaid