Provider Demographics
NPI:1336160183
Name:TALBOT, RALPH E
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:E
Last Name:TALBOT
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 1:391 BROADWAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3470
Mailing Address - Country:US
Mailing Address - Phone:617-381-0555
Mailing Address - Fax:949-955-7321
Practice Address - Street 1:391 BROADWAY
Practice Address - Street 2:SUITE 304
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3470
Practice Address - Country:US
Practice Address - Phone:617-381-0555
Practice Address - Fax:949-955-7321
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA441052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3060624Medicaid
E45518Medicare UPIN
MAJ09554TAMedicare ID - Type Unspecified