Provider Demographics
NPI:1326181710
Name:HAMILTON, TARA J (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:HAMILTON
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 1:170 GOVERNORS AVE
Mailing Address - Street 2:DIABETES CLINIC-LAWRENCE MEMORIAL HOSPITAL
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1643
Mailing Address - Country:US
Mailing Address - Phone:781-306-6370
Mailing Address - Fax:781-306-6375
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:DIABETES CLINIC-LAWRENCE MEMORIAL HOSPITAL
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-306-6370
Practice Address - Fax:781-306-6375
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221829207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA92172OtherHARVARD PILGRIM
MAJ41861OtherBLUE CROSS
MA0001507Medicare PIN