Provider Demographics
NPI:1619924263
Name:MUSCOVICH, TARA THURLBY (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:THURLBY
Last Name:MUSCOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1438 DEFENSE HIGHWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054
Mailing Address - Country:US
Mailing Address - Phone:410-721-3200
Mailing Address - Fax:410-721-2680
Practice Address - Street 1:1438 DEFENSE HIGHWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054
Practice Address - Country:US
Practice Address - Phone:410-721-3200
Practice Address - Fax:410-721-2680
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OM7OTTOtherBLUE CROSS BLUE SHIELD
080144695OtherRAILROAD RETIREMENT
2216536OtherCIGNA
33476OtherJOHNS HOPKINS HEALTH CARE
637917OtherINFORMED
1278653OtherUNITED HEALTHCARE
53940001OtherBLUE CROSS BLUE CHOICE
MD231121600Medicaid
355138OtherMAMSI
38536OtherCOVENTRY HEALTH
4205809OtherAETNA
P13977OtherBCBS MPOS
355138OtherALLIANCE
733208OtherNCPPO