Basic Information
| Provider Information | |||||||||
| NPI: | 1568424026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TASH | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 291 MOODY ST | ||||||||
| Address2: | |||||||||
| City: | LUDLOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010561246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006886663 | ||||||||
| FaxNumber: | 4135897554 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006886663 | ||||||||
| FaxNumber: | 4135822949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 203886 | MA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 04-2486823 | 01 | MA | NORTHEAST HEALTHCARE ALLI | OTHER | 000000023435 | 01 | MA | BMC | OTHER | 04-2486823 | 01 | MA | GREAT-WEST | OTHER | 04-2486823 | 01 | MA | NORTH AMERICAN PREFERRED | OTHER | 04-2486823 | 01 | MA | PHCS | OTHER | 243315 | 01 | MA | HARVARD PILGRIM | OTHER | J24661 | 01 | MA | BCBS MA | OTHER | 04-2486823 | 01 | MA | NORTHEAST HEALTH DIRECT | OTHER | 0191591 | 05 | MA | MEDICAID | 04-2486823 | 01 | MA | CONSOLIDATED | OTHER | 04-2486823 | 01 | MA | PLAN VISTA | OTHER | 04-2486823 | 01 | MA | UNICARE/GIC | OTHER | 203886 | 01 | MA | TUFTS | OTHER | 2837628 | 01 | MA | AETNA | OTHER | 6148632 | 01 | MA | CIGNA | OTHER |