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General NPI Number Information
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NPI Number | 1124016118
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Entity Type | Individual
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Provider Name | TARA KAY PELLETIER DO
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Gender | Female
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 11 HILLS BEACH RD
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City | BIDDEFORD
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State | ME
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Zip | 04005-9599
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Country | US
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Telephone | 207-602-2358
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Fax | 207-602-5904
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Provider Business Mailing Address
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Address Line | PO BOX 284
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City | BRATTLEBORO
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State | VT
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Zip | 05302-0284
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Country | US
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Telephone | 207-602-2358
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Fax | 207-602-5904
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 224963
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO1957
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License Number State | ME
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