Provider Demographics
NPI:1942348347
Name:TARTARO, JEROME ANTHONY
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ANTHONY
Last Name:TARTARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXECUTIVE BLDG
Mailing Address - Street 2:118 POINT JUDITH RD
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3439
Mailing Address - Country:US
Mailing Address - Phone:401-783-2937
Mailing Address - Fax:401-782-3620
Practice Address - Street 1:EXECUTIVE BLDG
Practice Address - Street 2:118 POINT JUDITH RD
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3439
Practice Address - Country:US
Practice Address - Phone:401-783-2937
Practice Address - Fax:401-782-3620
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI640800OtherUNITED HEALTH