Provider Demographics
NPI:1780007526
Name:MAREAN, TARA (LCAT)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:MAREAN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-2623
Mailing Address - Country:US
Mailing Address - Phone:914-271-4899
Mailing Address - Fax:914-271-4899
Practice Address - Street 1:1 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-2623
Practice Address - Country:US
Practice Address - Phone:914-271-4899
Practice Address - Fax:914-271-4899
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000453-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000453-1OtherLCAT
NC89-233OtherATR BC