Provider Demographics
NPI:1871606608
Name:TATOIAN, ROBERT D (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:TATOIAN
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 1:74 PALOMBA DR
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3858
Mailing Address - Country:US
Mailing Address - Phone:860-253-9190
Mailing Address - Fax:860-253-0047
Practice Address - Street 1:74 PALOMBA DR
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3858
Practice Address - Country:US
Practice Address - Phone:860-253-9190
Practice Address - Fax:860-253-0047
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1803213E00000X
CT000436213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004069464Medicaid
CT004069464Medicaid
T22435Medicare UPIN
MAY70820Medicare ID - Type Unspecified
CT480000334Medicare ID - Type Unspecified