Provider Demographics
NPI:1760637383
Name:TABBARA MEDICAL ENTERPRISE
Entity Type:Organization
Organization Name:TABBARA MEDICAL ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:BESHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TABBARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-645-2441
Mailing Address - Street 1:122 BOWDOIN ST
Mailing Address - Street 2:SUITE 96
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2710
Mailing Address - Country:US
Mailing Address - Phone:617-645-2441
Mailing Address - Fax:
Practice Address - Street 1:122 BOWDOIN ST
Practice Address - Street 2:SUITE 96
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2710
Practice Address - Country:US
Practice Address - Phone:617-645-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty