Provider Demographics
NPI:1497752034
Name:TARNELL, LAURIE A (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:A
Last Name:TARNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:ONE LYONS ST.
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-461-8235
Practice Address - Street 1:ONE LYONS ST.
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-461-8235
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A58321OtherFIRST SENIORITY
J05303OtherBS-BLUE CARE ELECT
27725OtherCHILDREN'S MEDICAL SECURI
61283OtherHARVARD/PILGRIM
760130OtherTUFTS COMMONWEALTH PPO
J05303OtherHMO BLUE/BLUE CHOICE
760130OtherTUFTS TOTAL HEALTH PLAN
0440878OtherUNITED HEALTHCARE (PPO)
61283OtherHARVARD PILGRIM POS
760130OtherTUFTS
7999348OtherCIGNA HEALTH CARE
7999348OtherHEALTHSOURCE MA
J05303OtherBLUE SHIELD-INDEMNITY
0016053OtherNEIGHBORHOOD HEALTH PLAN
110128583OtherRAILROAD MEDICARE
3011038OtherMASS HEALTH (DIV OF MED S
61283OtherHARVARD PILGRIM PPO
760130OtherTUFTS BENEFIT ADMINSTRATO
61283OtherHARVARD PILGRIM POS
A58321OtherFIRST SENIORITY