Provider Demographics
NPI:1598835241
Name:BIRD, TARAH MELANY (PA)
Entity Type:Individual
Prefix:MS
First Name:TARAH
Middle Name:MELANY
Last Name:BIRD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BETHEL LOOP
Mailing Address - Street 2:APT2H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1721
Mailing Address - Country:US
Mailing Address - Phone:718-642-2974
Mailing Address - Fax:
Practice Address - Street 1:200 BETHEL LOOP
Practice Address - Street 2:APT2H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1721
Practice Address - Country:US
Practice Address - Phone:718-642-2974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant