Provider Demographics
NPI:1205010428
Name:BRYANT A TARR DPM
Entity type:Organization
Organization Name:BRYANT A TARR DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:A
Authorized Official - Last Name:TARR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-443-4878
Mailing Address - Street 1:111 BOSTON POST RD
Mailing Address - Street 2:STE108
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2463
Mailing Address - Country:US
Mailing Address - Phone:978-443-4878
Mailing Address - Fax:978-443-1470
Practice Address - Street 1:111 BOSTON POST RD
Practice Address - Street 2:SUITE 108
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2463
Practice Address - Country:US
Practice Address - Phone:978-443-4878
Practice Address - Fax:978-443-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001971213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0993090001Medicare NSC