Provider Demographics
NPI:1740271147
Name:NOLAN, TARA MARIE (MD)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:MARIE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:NAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:60 MESSENGER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2258
Mailing Address - Country:US
Mailing Address - Phone:508-809-6378
Mailing Address - Fax:508-809-6366
Practice Address - Street 1:60 MESSENGER ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2258
Practice Address - Country:US
Practice Address - Phone:508-809-6378
Practice Address - Fax:508-809-6366
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2086140Medicaid
491332OtherTUFTS USFHP
469891OtherTUFTS
43283986OtherUNITED
7109870OtherCIGNA
MAJ28131OtherBCBS
MAAA19289OtherHPHC
43283986OtherUNITED
MA2086140Medicaid