Provider Demographics
NPI:1477516516
Name:TAM, JENNIFER L (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:TAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:781-534-7100
Mailing Address - Fax:781-534-7358
Practice Address - Street 1:300 LINDEN PONDS WAY
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3769
Practice Address - Country:US
Practice Address - Phone:781-534-7100
Practice Address - Fax:781-534-7358
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA154342207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3192245Medicaid
04-09588OtherEVERCARE
409588OtherTRICARE NORTH
1477516516OtherBCBS
AA48828OtherHARVARD PILGRIM
MA3192245Medicaid
1477516516OtherBCBS
A29312Medicare PIN