Provider Demographics
NPI:1689625642
Name:MARTIN, TAMARA L (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:850 BOYLSTON STREET
Mailing Address - Street 2:BRIGHAM AND WOMENS HOSPITAL DEPT OF ORTHOPEDIC SURGERY
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467
Mailing Address - Country:US
Mailing Address - Phone:617-732-5724
Mailing Address - Fax:
Practice Address - Street 1:850 BOYLSTON STREET
Practice Address - Street 2:BRIGHAM AND WOMENS HOSPITAL DEPT OF ORTHOPEDIC SURGERY
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467
Practice Address - Country:US
Practice Address - Phone:617-732-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81839207X00000X
MAMA81839207XX0005X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery