Provider Demographics
NPI:1861428500
Name:MITRA, TANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:TANDRA
Middle Name:
Last Name:MITRA
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 1:1705 WAMPANOAG TRL
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1709
Mailing Address - Country:US
Mailing Address - Phone:401-246-2827
Mailing Address - Fax:508-961-5750
Practice Address - Street 1:101 PAGE STREET
Practice Address - Street 2:ST LUKE'S HOSPITAL
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-961-5006
Practice Address - Fax:508-961-5750
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227523207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease