Provider Demographics
NPI:1851325310
Name:TARDIF, ROBERT P (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:TARDIF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HILLVIEW LN
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1705
Mailing Address - Country:US
Mailing Address - Phone:207-754-1887
Mailing Address - Fax:
Practice Address - Street 1:330 SABATTUS STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-777-4300
Practice Address - Fax:207-755-3021
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1308207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME265590099Medicaid
MEMM491901OtherMEDICARE PTAN
MEMM491901OtherMEDICARE PTAN
MEF62728Medicare UPIN