Individual
TANYA GIRGENRATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 421-1400
(508) 421-1490
Mailing address
55 LAKE AVE N, WORCESTER, MA 01655-0002
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
282382
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110124658A
—
MA
Enumeration date
03/22/2017
Last updated
11/19/2020
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