Provider Demographics
NPI:1225122401
Name:TOMASSO, TARA M (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:M
Last Name:TOMASSO
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 1:612 GLASSBORO RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1423
Mailing Address - Country:US
Mailing Address - Phone:856-845-0323
Mailing Address - Fax:856-845-4322
Practice Address - Street 1:612 GLASSBORO RD
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1423
Practice Address - Country:US
Practice Address - Phone:856-845-0323
Practice Address - Fax:856-845-4322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07152700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050351Medicare ID - Type Unspecified
NJH46275Medicare UPIN