Provider Demographics
NPI:1942209390
Name:TARNELL, ELIZABETH B (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:TARNELL
Suffix:
Gender:F
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:PO BOX 9120
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02027-9120
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-326-5760
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-326-5760
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0016052OtherNEIGHBORHOOD HEALTH PLAN
073363OtherTUFTS TOTAL HEALTH PLAN
48-00085OtherUNITED HEALTHCARE HMO/PPO
61325OtherHARVARD PILGRIM PPO
J10302OtherBS-BLUE CARE ELECT
110116275OtherRAILROAD MEDICARE
3069877OtherMASS.HEALTH(DIV.MEDSVCS)
073363OtherTUFTS
073363OtherTUFTS COMMONWEALTH PPO
E60752OtherFIRST SENIORITY
J10302OtherBLUE SHIELD - INDEMNITY
J10302OtherHMO BLUE/BLUE CHOICE
073363OtherTUFTS BENEFIT ADMIN.
27722OtherCHILDREN'S MED. SECURITY
5420596OtherHEALTHSOURCE MASSACHUSETT
61325OtherHARVARD PILGRIM POS
5420598OtherCIGNA HEALTH CARE
61325OtherHARVARD PILGRIM
3069877OtherMASS.HEALTH(DIV.MEDSVCS)