Provider Demographics
NPI:1356321780
Name:DARA, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:DARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1453
Mailing Address - Country:US
Mailing Address - Phone:973-835-2575
Mailing Address - Fax:973-835-0531
Practice Address - Street 1:28 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1453
Practice Address - Country:US
Practice Address - Phone:973-835-2575
Practice Address - Fax:973-835-0531
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ43399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3303306Medicaid
NJ3303306Medicaid
NJ058650MDJMedicare PIN