Provider Demographics
NPI:1386639227
Name:COLAIZY, TARAH TRINITY (MD)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:TRINITY
Last Name:COLAIZY
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-3508
Mailing Address - Fax:319-356-4685
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-3508
Practice Address - Fax:319-356-4508
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA357792080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0445452Medicaid
IA37077OtherWELLMARK BCBS
IA37077OtherWELLMARK BCBS
IAI13155Medicare PIN