Provider Demographics
NPI:1689677890
Name:ROBINSON, TARA S (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:S
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4330 NAVARRE AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3587
Mailing Address - Country:US
Mailing Address - Phone:419-691-7820
Mailing Address - Fax:419-691-7593
Practice Address - Street 1:4330 NAVARRE AVE
Practice Address - Street 2:STE 103
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3587
Practice Address - Country:US
Practice Address - Phone:419-691-7820
Practice Address - Fax:419-691-7593
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-07-8608-R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2216551Medicaid
OHRO4029921Medicare ID - Type Unspecified
OH2216551Medicaid