Healthcare Provider Details

I. General information

NPI: 1316630452
Provider Name (Legal Business Name): ALEXIS REBECCA TAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 FALMOUTH RD
MARSTONS MILLS MA
02648-1855
US

IV. Provider business mailing address

3880 FALMOUTH RD
MARSTONS MILLS MA
02648-1855
US

V. Phone/Fax

Practice location:
  • Phone: 508-492-3200
  • Fax:
Mailing address:
  • Phone: 508-492-3200
  • Fax: 508-492-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA100659
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: