Provider Demographics
NPI:1215041736
Name:CRANE, TARA DIANNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:DIANNE
Last Name:CRANE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25029 NORTHWESTERN PIKE
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-6203
Mailing Address - Country:US
Mailing Address - Phone:540-570-0090
Mailing Address - Fax:304-822-4452
Practice Address - Street 1:25029 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-6203
Practice Address - Country:US
Practice Address - Phone:304-822-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00958231H00000X
VA2201001169231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00714949OtherRR MEDICARE
MD93294101OtherCAREFIRST OF MD
MD407053400Medicaid
MDJ8130002OtherGHMSI & BLUECHOICE
MDJ8130002OtherGHMSI & BLUECHOICE