Provider Demographics
NPI:1780645663
Name:TADIRI, RONALD S (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:TADIRI
Suffix:
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 1:64 BOYDEN RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2570
Mailing Address - Country:US
Mailing Address - Phone:508-885-2003
Mailing Address - Fax:508-885-8071
Practice Address - Street 1:64 BOYDEN RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520
Practice Address - Country:US
Practice Address - Phone:508-885-2003
Practice Address - Fax:508-885-8071
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
9900823OtherFALLON COMMUNITY HEALTH P
784244OtherMVP HEALTH CARE
9602726OtherCIGNA HEALTH PLAN
J11038OtherBLUE SHIELD HMO BLUE
AA1181OtherHARVARD PILGRIM HEALTHCAR
33867OtherCHILDRENS MEDICAL SECURIT
935033OtherFIRST HEALTH
J11038OtherBLUE CARE ELECT
J11038OtherBLUE SHIELD INDEMNITY
MA110050631AMedicaid
043058466OtherHEALTHCARE VALUE MANAGEME
3085686OtherWELFARE
042472266OtherONE HEALTH PLAN
33867OtherHEALTHY START
042472266OtherTHREE RIVERS
5576020OtherAETNA US HEALTHCARE
935033OtherFIRST HEALTH
E84785Medicare UPIN
MAJ11038Medicare ID - Type Unspecified