Provider Demographics
NPI:1316946312
Name:TAFRA, LORRAINE (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:TAFRA
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:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6573
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:443-481-5300
Practice Address - Fax:443-481-6705
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055097208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2216835OtherAETNA HMO
MD844101400Medicaid
DCV8380003OtherBCBS
58860001OtherBCBS DC
DCV8740002OtherBCBS
4589970OtherAETNA PPO
851607OtherUNICARE NCPPO
0001OtherCAREFIRST
MD77987403OtherBCBS
MD77987405OtherBCBS
DCV8080003OtherBCBS
77987401OtherBCBS MD
77987404OtherBCBS MARYLAND
MD77987405OtherBCBS
MD844101400Medicaid
171262Y5ZMedicare PIN
77987401OtherBCBS MD
MD77987403OtherBCBS
020044901Medicare PIN
171262ZDWSMedicare PIN
851607OtherUNICARE NCPPO
172125YBL9Medicare PIN