Provider Demographics
NPI:1245227925
Name:TAVARES, JOAO M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAO
Middle Name:M
Last Name:TAVARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3238
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-3238
Mailing Address - Country:US
Mailing Address - Phone:866-689-8862
Mailing Address - Fax:207-347-7401
Practice Address - Street 1:34 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5204
Practice Address - Country:US
Practice Address - Phone:508-862-5650
Practice Address - Fax:508-778-4753
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI696689OtherHARVARD HEALTH CARE
RI9024180Medicaid
RI04-07499OtherUNITED HEALTH CARE
RI050483739OtherGREAT WEST HEALTH CARE
RI111480OtherTUFTS HEALTH PLAN
RI24180-3OtherBCBS OF RI
RI410404OtherBLUE CHIP
RI5477977OtherHEALTH CARE VALUE MGMT
RI28468OtherNEIGHBORHOOD HEALTH PLAN
RI050483739OtherHEALTH NET TRI CARE
RI709003710OtherMEDICARE GROUP
RI9622889001OtherCIGNA
RI709003710OtherMEDICARE GROUP
RI709003710OtherMEDICARE GROUP
RI050483739OtherHEALTH NET TRI CARE