Provider Demographics
NPI:1700840873
Name:TARA, CHARLES S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:TARA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:307 LINDSAY ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4827
Practice Address - Country:US
Practice Address - Phone:336-802-2020
Practice Address - Fax:336-802-2021
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC17082207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127MGMedicaid
NCP00828557OtherRR MEDICARE
NCC86689Medicare UPIN
NC210845CMedicare PIN
NC210845AMedicare ID - Type Unspecified