Provider Demographics
NPI:1528034659
Name:WINCHESTER, TARA D (DO)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:D
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4218
Mailing Address - Country:US
Mailing Address - Phone:330-965-0909
Mailing Address - Fax:330-965-0897
Practice Address - Street 1:1111 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4218
Practice Address - Country:US
Practice Address - Phone:330-965-0909
Practice Address - Fax:330-965-0897
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008076207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430882Medicaid
OH4132351Medicare PIN
OHI06203Medicare UPIN