MEDICARE: DR. ROY PAUL TARR D.P.M.

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	213E00000X	Podiatrist	1475	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	:	1558364182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY PAUL TARR D.P.M.

Provider Business Mailing Address
First Line	:	100 HIGHLAND ST
Second Line	:	STE 122
City	:	MILTON
State	:	MA
Zip	:	02186-3878
Country	:	US
Telephone Number	:	617-698-4830
Fax Number	:	617-698-3668

Provider Business Practice Location Address
First Line	:	100 HIGHLAND ST
Second Line	:	STE 122
City	:	MILTON
State	:	MA
Zip	:	02186-3878
Country	:	US
Telephone Number	:	617-698-4830
Fax Number	:	617-698-3668

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/10/2010

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