Provider Demographics
NPI:1790714038
Name:BYRNE, TARA (RPA-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BYRNE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-2010
Mailing Address - Country:US
Mailing Address - Phone:518-943-9100
Mailing Address - Fax:518-943-9101
Practice Address - Street 1:10 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-2010
Practice Address - Country:US
Practice Address - Phone:518-943-9100
Practice Address - Fax:518-943-9101
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant