Provider Demographics
NPI:1952662264
Name:RICHARDSON, TARA L (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:K
Other - Last Name:LOISEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HOLLISTER PEDIATRIC GROUP
Mailing Address - Street 2:321 FORTUNE BOUKEVARD
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757
Mailing Address - Country:US
Mailing Address - Phone:508-478-5996
Mailing Address - Fax:508-634-7857
Practice Address - Street 1:HOLLISTER PEDIATRIC GROUP
Practice Address - Street 2:321 FORTUNE BOUKEVARD
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-478-5996
Practice Address - Fax:508-634-7857
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262708208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics