=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851325310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT P TARDIF DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 11/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 SABATTUS STREET
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-777-4300
-----------------------------------------------------
Fax | 207-755-3021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 HILLVIEW LN
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04240-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-754-1887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 1308
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------