Individual
KEVIN J TALLY
Active
Individual
KEVIN J TALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
042086
CT
207UN0901X
Nuclear Cardiology Physician
042086
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001420869
—
CT
01
—
010042086CT01
ANTHEM BCBS
CT
01
—
060001631
MCPIN CT HEART PHYSICIANS
CT
01
—
C00585
PTAN CONS. CARDIOLOGISTS
CT
01
—
CA7937
RAILROAD MEDICARE GROUP #
CT
01
—
P00233421
RAILROAD MEDICARE
CT
Enumeration date
10/25/2005
Last updated
05/20/2015
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