Provider Demographics
NPI:1376742742
Name:BARNETT, TARA MICHELLE (PAC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 BEACON ST
Mailing Address - Street 2:UNIT 67
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1322
Mailing Address - Country:US
Mailing Address - Phone:617-670-3606
Mailing Address - Fax:
Practice Address - Street 1:2014 WASHINGTON STREET
Practice Address - Street 2:NEWTON WELLESLEY HOSPITAL
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-6040
Practice Address - Fax:508-946-1494
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAAP2352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant