Provider Demographics
NPI:1760516611
Name:GEHA, TARA A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:A
Last Name:GEHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:A
Other - Last Name:PIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:567-585-0460
Mailing Address - Fax:567-585-0461
Practice Address - Street 1:7634 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1526
Practice Address - Country:US
Practice Address - Phone:567-585-0460
Practice Address - Fax:567-585-0461
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002589363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00835876OtherRRMC
OH000000526589OtherANTHEM
OHPIPA28701Medicare PIN
OHQ78389Medicare UPIN
OH000000526589OtherANTHEM