Provider Demographics
NPI:1487831418
Name:BARROSO, TANIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:A
Last Name:BARROSO
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 1:9095 NESBIT LAKES DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4041
Mailing Address - Country:US
Mailing Address - Phone:646-732-3859
Mailing Address - Fax:
Practice Address - Street 1:9095 NESBIT LAKES DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4041
Practice Address - Country:US
Practice Address - Phone:646-732-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2741208100000X
GA63628208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation