Provider Demographics
NPI:1366433666
Name:TOMKINS, PARRA (MD)
Entity type:Individual
Prefix:
First Name:PARRA
Middle Name:
Last Name:TOMKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 BROADWAY
Mailing Address - Street 2:BALL SQUARE
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2528
Mailing Address - Country:US
Mailing Address - Phone:617-625-0006
Mailing Address - Fax:617-625-6644
Practice Address - Street 1:645 BROADWAY
Practice Address - Street 2:BALL SQUARE
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2528
Practice Address - Country:US
Practice Address - Phone:617-625-0006
Practice Address - Fax:617-625-6644
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3198481Medicaid
MA3198481Medicaid
MAA30055Medicare PIN