Provider Demographics
NPI:1629037445
Name:PHARR, TARKTEN A (MD,RVT)
Entity Type:Individual
Prefix:DR
First Name:TARKTEN
Middle Name:A
Last Name:PHARR
Suffix:
Gender:M
Credentials:MD,RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 N ROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3388
Mailing Address - Country:US
Mailing Address - Phone:252-384-2560
Mailing Address - Fax:252-384-9997
Practice Address - Street 1:1177 N ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3388
Practice Address - Country:US
Practice Address - Phone:252-384-2560
Practice Address - Fax:252-384-9997
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001012632086S0129X, 208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891296VMedicaid
NCG89461Medicare UPIN
NC2293464CMedicare PIN
NC2293464CMedicare PIN