Provider Demographics
NPI:1760479075
Name:TALLMAN, CARTER B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:B
Last Name:TALLMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1111
Mailing Address - Country:US
Mailing Address - Phone:413-734-5661
Mailing Address - Fax:
Practice Address - Street 1:3377 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1111
Practice Address - Country:US
Practice Address - Phone:413-734-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78102207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF77903OtherUPIN PREVIOUS MEDICARE
MA3121780Medicaid
MAGX3202Medicare UPIN
MA3121780Medicaid