MEDICARE: THOM A. TARQUINIO M.D.

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	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	15008	MS
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	49422	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	512G700003	OTHER	MS	UP MEDICARE
2	512I200010	OTHER	MS	UP MEDICARE PTAN
4	200025582	OTHER	MS	RAILROAD MEDICARE
5	200000249	OTHER	MS	MEDICARE ID NOVARTIS SOLUTIONS
6	P00462327	OTHER	MS	RAILROAD MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1265434229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOM A. TARQUINIO M.D.

Provider Business Mailing Address
First Line	:	630 PLANTATION ST
Second Line	:	WOT 12TH FL
City	:	WORCESTER
State	:	MA
Zip	:	01605-2038
Country	:	US
Telephone Number	:	508-368-5532
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 SUMMER ST
Second Line	:	SUITE 320
City	:	WORCESTER
State	:	MA
Zip	:	01608-1216
Country	:	US
Telephone Number	:	508-368-3140
Fax Number	:	508-368-3143

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/23/2013

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Directions to “ THOM A. TARQUINIO M.D.” Practice Location

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