Provider Demographics
NPI:1235101734
Name:TARR, DIANE E (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
Last Name:TARR
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:BOX 1170
Mailing Address - Street 2:1176 FIFTH AVENUE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-5995
Mailing Address - Fax:212-241-3833
Practice Address - Street 1:1176 5TH AVE # 1170
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:212-241-5995
Practice Address - Fax:212-241-3833
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247925207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3094715Medicaid
MAE99417Medicare UPIN
MA3094715Medicaid