Provider Demographics
NPI:1639269434
Name:GARG, TARSEM C (MD)
Entity Type:Individual
Prefix:MR
First Name:TARSEM
Middle Name:C
Last Name:GARG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505
Mailing Address - Country:US
Mailing Address - Phone:937-328-2329
Mailing Address - Fax:937-328-2393
Practice Address - Street 1:1929 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505
Practice Address - Country:US
Practice Address - Phone:937-328-2329
Practice Address - Fax:937-328-2393
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0386672084A0401X
OH35038667207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0296924Medicaid
OH0417803Medicare Oscar/Certification
OH0296924Medicaid
OH0271270001Medicare NSC