Provider Demographics
NPI:1518002393
Name:ARAI, TARO (MD)
Entity Type:Individual
Prefix:
First Name:TARO
Middle Name:
Last Name:ARAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3442
Mailing Address - Country:US
Mailing Address - Phone:610-446-7882
Mailing Address - Fax:610-446-3316
Practice Address - Street 1:1010 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3442
Practice Address - Country:US
Practice Address - Phone:610-446-7882
Practice Address - Fax:610-446-3316
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD48802L208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01669048Medicaid
729486OtherPA BLUE SHIELD
0571771000OtherKEYSTONE HEALTH PLAN
PA01669048Medicaid
729486OtherPA BLUE SHIELD