Provider Demographics
NPI:1689807893
Name:TARNAVSKY, TETYANA (MD,PHD)
Entity Type:Individual
Prefix:
First Name:TETYANA
Middle Name:
Last Name:TARNAVSKY
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:TETYANA
Other - Middle Name:
Other - Last Name:TARNAVSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:63 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4042
Mailing Address - Country:US
Mailing Address - Phone:508-559-6699
Mailing Address - Fax:508-559-5073
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4042
Practice Address - Country:US
Practice Address - Phone:508-559-6699
Practice Address - Fax:508-559-5073
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241639390200000X
MA2534202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program