Provider Demographics
NPI:1609963990
Name:LAIR, TARA (PA-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LAIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7794 FIVE MILE ROAD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230
Mailing Address - Country:US
Mailing Address - Phone:513-231-1575
Mailing Address - Fax:855-818-3918
Practice Address - Street 1:7794 5 MILE RD STE 240
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2372
Practice Address - Country:US
Practice Address - Phone:513-231-1575
Practice Address - Fax:855-818-3918
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50004547RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160056Medicaid
KY7100220510Medicaid
KYK174021Medicare PIN
OH0160056Medicaid
KYK174020Medicare PIN