Provider Demographics
NPI:1760475495
Name:TARR, DAVID S (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:TARR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 MERRIMACK ST
Mailing Address - Street 2:P. O. BOX 9009
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1720
Mailing Address - Country:US
Mailing Address - Phone:978-441-0197
Mailing Address - Fax:978-441-0177
Practice Address - Street 1:92 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1720
Practice Address - Country:US
Practice Address - Phone:978-441-0197
Practice Address - Fax:978-441-0177
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1469213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0360902Medicaid
MAY70752Medicare ID - Type Unspecified
MAYY7067Medicare ID - Type UnspecifiedMEDICARE NUMBER /MASS.