Provider Demographics
NPI:1346238722
Name:TAFFE, CALLIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:M
Last Name:TAFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:89 FOSS ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1839
Mailing Address - Country:US
Mailing Address - Phone:781-391-0340
Mailing Address - Fax:
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:SUITE 4100
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:617-864-8822
Practice Address - Fax:617-547-5367
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3086879Medicaid
MAE97940Medicare UPIN
MA3086879Medicaid