Provider Demographics
NPI:1073578589
Name:PERSAUD, TAREK OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:OMAR
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TAREK
Other - Middle Name:
Other - Last Name:HOSEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 MERIDIAN ST N
Mailing Address - Street 2:400
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4720
Mailing Address - Country:US
Mailing Address - Phone:256-539-8851
Mailing Address - Fax:256-534-7203
Practice Address - Street 1:401 MERIDIAN ST N
Practice Address - Street 2:400
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4720
Practice Address - Country:US
Practice Address - Phone:256-539-8851
Practice Address - Fax:256-534-7203
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00027315207W00000X
AL27315207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL112997Medicaid
ALI57277Medicare UPIN
AL102I185111Medicare PIN