Provider Demographics
NPI:1164494498
Name:TARTER, YASMIN L (MD)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:L
Last Name:TARTER
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-217-7991
Practice Address - Street 1:3031 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4951
Practice Address - Country:US
Practice Address - Phone:540-736-5043
Practice Address - Fax:540-736-5044
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACA9037OtherMCR RAILROAD GROUP
VA0101226899OtherLICENSE
VA005610753Medicaid
VA4099775OtherAETNA NON HMO
VA137705OtherANTHEM
VA2579753OtherAETNA HMO
VA000129191OtherAETNA CAP
VA888837OtherMAMSI
VAC02375OtherMEDICARE GROUP
VA080007501Medicare PIN
VA2579753OtherAETNA HMO
VA0101226899OtherLICENSE
VA324027YWAUMedicare PIN
VA888837OtherMAMSI