Provider Demographics
NPI:1477879641
Name:EDWARD TARAS MD INC
Entity Type:Organization
Organization Name:EDWARD TARAS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:TARAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-887-0050
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:#535
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2006
Mailing Address - Country:US
Mailing Address - Phone:818-887-0050
Mailing Address - Fax:818-887-5500
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:#535
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2006
Practice Address - Country:US
Practice Address - Phone:818-887-0050
Practice Address - Fax:818-887-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77271207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG39495Medicare UPIN