Provider Demographics
NPI:1114343993
Name:MCNALLY, TARA ANN MARGARET (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN MARGARET
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:MARGARET
Other - Last Name:FATULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8003
Mailing Address - Street 2:1 MEDICAL CENTER DR.
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506
Mailing Address - Country:US
Mailing Address - Phone:304-293-4121
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant