Provider Demographics
NPI:1437543717
Name:O'MEARA, TARA ANN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:BEHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2522
Mailing Address - Country:US
Mailing Address - Phone:781-738-8355
Mailing Address - Fax:
Practice Address - Street 1:95 WELLS ST
Practice Address - Street 2:SUITE 320
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:844-744-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant