Provider Demographics
NPI:1992826408
Name:TARI, BRANDON K
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:K
Last Name:TARI
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 1:825 WASHINGTON ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3441
Mailing Address - Country:US
Mailing Address - Phone:781-762-2600
Mailing Address - Fax:781-769-3723
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-762-2600
Practice Address - Fax:781-769-3723
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250234208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery