Provider Demographics
NPI:1326142829
Name:ANDERSON, TARI S (MD)
Entity Type:Individual
Prefix:MRS
First Name:TARI
Middle Name:S
Last Name:ANDERSON
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 1:5777 KELLOGG AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-7142
Mailing Address - Country:US
Mailing Address - Phone:513-232-3232
Mailing Address - Fax:513-232-3202
Practice Address - Street 1:5777 KELLOGG AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230
Practice Address - Country:US
Practice Address - Phone:513-232-3232
Practice Address - Fax:513-232-3202
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058827207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6418350001OtherMEDICARE DME
OH6418350001OtherMEDICARE DME
OH6418350001Medicare NSC
OHF29710Medicare UPIN