Basic Information
| Provider Information | |||||||||
| NPI: | 1013341163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIRACUSA | ||||||||
| FirstName: | TAMAR | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 W SQUANTUM ST | ||||||||
| Address2: | |||||||||
| City: | NORTH QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021712122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173763000 | ||||||||
| FaxNumber: | 6177741906 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 W SQUANTUM ST | ||||||||
| Address2: | |||||||||
| City: | NORTH QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021712122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173763000 | ||||||||
| FaxNumber: | 6177741905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2013 | ||||||||
| LastUpdateDate: | 12/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN2278596 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LW0102X | RN2278596 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.