MEDICARE: DR. TANIA M BANDAK MD

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
1	207Q00000X	Family Medicine Physician	214215	MA

Other Identifiers

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

General Provider Information

NPI Number	:	1134102064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANIA M BANDAK MD

Provider Business Mailing Address
First Line	:	109 ANDREW AVE
Second Line	:
City	:	WAYLAND
State	:	MA
Zip	:	01778-3156
Country	:	US
Telephone Number	:	781-453-8450
Fax Number	:	781-453-8470

Provider Business Practice Location Address
First Line	:	109 ANDREW AVE
Second Line	:
City	:	WAYLAND
State	:	MA
Zip	:	01778-3156
Country	:	US
Telephone Number	:	781-453-8450
Fax Number	:	781-453-8470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	11/26/2014

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