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NPI Code Detail

MEDICARE: MS. SAVATRI TACK NP

MEDICARE: MS. SAVATRI TACK NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner207349MA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11974901OTHERMAMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053612788
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SAVATRI TACK NP
Provider Business Mailing Address
First Line : 1200 CENTRE STREET
Second Line : DEPARTMENT OF MEDICINE
City : ROSLINDALE
State : MA
Zip : 02131-1000
Country : US
Telephone Number : 617-363-8010
Fax Number : 617-363-8929
Provider Business Practice Location Address
First Line : 1200 CENTRE STREET
Second Line : DEPARTMENT OF MEDICINE
City : ROSLINDALE
State : MA
Zip : 02131-1000
Country : US
Telephone Number : 617-363-8010
Fax Number : 617-363-8929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2010
Last Update Date : 07/02/2015

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