Provider Demographics
NPI:1770516189
Name:TARNAS, ROBERT H (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:TARNAS
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 1:30 VT ROUTE 100 S
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05363-7944
Mailing Address - Country:US
Mailing Address - Phone:802-464-5311
Mailing Address - Fax:802-464-7480
Practice Address - Street 1:30 VT ROUTE 100 S
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:VT
Practice Address - Zip Code:05363-7944
Practice Address - Country:US
Practice Address - Phone:802-464-5311
Practice Address - Fax:802-464-7480
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0007233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006641Medicaid
VT0006641Medicaid
E74947Medicare UPIN
VTP00365311Medicare PIN