Provider Demographics
NPI:1558364182
Name:TARR, ROY PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:PAUL
Last Name:TARR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:STE 122
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3878
Mailing Address - Country:US
Mailing Address - Phone:617-698-4830
Mailing Address - Fax:617-698-3668
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:STE 122
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3878
Practice Address - Country:US
Practice Address - Phone:617-698-4830
Practice Address - Fax:617-698-3668
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1475213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0330183Medicaid
MAY70596Medicare PIN
MA0508350001Medicare NSC
MAT58675Medicare UPIN