Provider Demographics
NPI:1790858793
Name:WOOD, TARA R (DO)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:R
Last Name:WOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4321 KELLY OAK CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7639
Mailing Address - Country:US
Mailing Address - Phone:919-285-3085
Mailing Address - Fax:919-822-6653
Practice Address - Street 1:115 KILDAIRE PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8144
Practice Address - Country:US
Practice Address - Phone:919-387-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE562197286OtherTAX IDENTIFICATION
NC200500281OtherLICENSE