Provider Demographics
NPI:1497989487
Name:SUMMERS, TARA E
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:E
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 EASTERN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5668
Mailing Address - Country:US
Mailing Address - Phone:919-264-6246
Mailing Address - Fax:
Practice Address - Street 1:3605 EASTERN BRANCH RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5668
Practice Address - Country:US
Practice Address - Phone:919-264-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator