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NPI Code Detail

MEDICARE: JESSICA MARIE TANNIAN

MEDICARE: JESSICA MARIE TANNIAN
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
1363A00000XPhysician AssistantPA102145MA

General Provider Information

NPI Number : 1326640186
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MARIE TANNIAN
Provider Business Mailing Address
First Line : 14A CARNATION CIR
Second Line :
City : READING
State : MA
Zip : 01867-2774
Country : US
Telephone Number : 978-697-1679
Fax Number :
Provider Business Practice Location Address
First Line : 2284 MAIN ST
Second Line :
City : CONCORD
State : MA
Zip : 01742-3829
Country : US
Telephone Number : 978-369-5575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2020
Last Update Date : 11/24/2025

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Directions to “ JESSICA MARIE TANNIAN ” Practice Location

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