Provider Demographics
NPI:1154337541
Name:TAITZ, MARSHALL M (DPM)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:M
Last Name:TAITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 DURFEE ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-674-1400
Mailing Address - Fax:508-673-2146
Practice Address - Street 1:164 DURFEE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-674-1400
Practice Address - Fax:508-673-2146
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1574213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5819OtherNEIGHBOR HEALTH PLAN
7072OtherBLUE SHIELD RI
001574OtherTUFTS
1819138OtherCIGNA
33034OtherHARVARD PILGRIM
402653OtherBLUE CHIP
MA9778594Medicaid
1819138OtherCIGNA
5819OtherNEIGHBOR HEALTH PLAN
MALX0150Medicare PIN
402653OtherBLUE CHIP
MAY77154Medicare PIN