Provider Demographics
NPI:1043289739
Name:AZAR, TARANEH (MD)
Entity Type:Individual
Prefix:
First Name:TARANEH
Middle Name:
Last Name:AZAR
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 1:35 WALKER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1727
Mailing Address - Country:US
Mailing Address - Phone:207-475-0100
Mailing Address - Fax:207-351-3524
Practice Address - Street 1:14 MANCHESTER SQ STE 210
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7905
Practice Address - Country:US
Practice Address - Phone:207-475-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22343207Y00000X
NH11236207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075199Medicaid
H41497Medicare UPIN
NHRE6244Medicare ID - Type Unspecified