Provider Demographics
NPI:1649236464
Name:TARAS, CATHERINE Y (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:Y
Last Name:TARAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:A
Other - Last Name:YURKEWYCZ-TARAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3780 MEDINA RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9311
Mailing Address - Country:US
Mailing Address - Phone:330-723-3256
Mailing Address - Fax:330-722-6731
Practice Address - Street 1:3780 MEDINA RD
Practice Address - Street 2:SUITE 250
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9311
Practice Address - Country:US
Practice Address - Phone:330-723-3256
Practice Address - Fax:330-722-6731
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058835Y207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170078Medicaid
F02977Medicare UPIN
0703598Medicare PIN