Provider Demographics
NPI:1265434229
Name:TARQUINIO, THOM A (MD)
Entity type:Individual
Prefix:
First Name:THOM
Middle Name:A
Last Name:TARQUINIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 320
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-368-3140
Practice Address - Fax:508-368-3143
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15008207XX0004X
MA49422207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512G700003OtherUP MEDICARE
MS512I200010OtherUP MEDICARE PTAN
MS117289Medicaid
MS200025582OtherRAILROAD MEDICARE
MS200000249OtherMEDICARE ID NOVARTIS SOLUTIONS
MSP00462327OtherRAILROAD MEDICARE PTAN
MS117289Medicaid
MS200025582OtherRAILROAD MEDICARE
MSA68066Medicare UPIN