Provider Demographics
NPI:1558394544
Name:FUTRELL, TARA D (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:D
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:48 SANDERSON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2778
Practice Address - Country:US
Practice Address - Phone:413-387-4125
Practice Address - Fax:413-773-2567
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA227214207R00000X, 208000000X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1338089OtherAETNA/US HEALTHCARE
MA491532OtherUS FAMILY HEALTH PLAN
MAP00328715OtherRAILROAD MEDICARE
MA2125145Medicaid
MA5675563OtherCIGNA
MAJ40314OtherBLUE CROSS BLUE SHIELD
MA227214OtherCONNECTICARE, INC.
MA524454OtherFALLON COMMUNITY HEALTH
MAI56823Medicare UPIN
MA000000035855OtherBMC HEALTHNET
MA38476OtherHEALTH NEW ENGLAND
MAA39992Medicare PIN
MA495000OtherTUFTS HEALTH PLAN
MAAA66525OtherHARVARD PILGRIM HEALTH