Provider Demographics
NPI:1821727405
Name:THE PARLOR RECONSTRUCTIVE TATTOOS, LLC
Entity Type:Organization
Organization Name:THE PARLOR RECONSTRUCTIVE TATTOOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABBIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-312-7921
Mailing Address - Street 1:209 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5962
Mailing Address - Country:US
Mailing Address - Phone:617-312-7921
Mailing Address - Fax:
Practice Address - Street 1:14 NASON ST STE 203
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-2594
Practice Address - Country:US
Practice Address - Phone:781-658-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Single Specialty