Provider Demographics
NPI:1063486637
Name:PAOLINI, TARA SOSA (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:SOSA
Last Name:PAOLINI
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 1:8207 MAIN ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6060
Mailing Address - Country:US
Mailing Address - Phone:716-204-8730
Mailing Address - Fax:
Practice Address - Street 1:8207 MAIN STREET
Practice Address - Street 2:SUITE 14
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6060
Practice Address - Country:US
Practice Address - Phone:716-204-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204202207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA2653Medicare ID - Type Unspecified
NYH43248Medicare UPIN