Provider Demographics
NPI:1821005059
Name:PAUL A TARANTINO, M.D.,P.A.
Entity Type:Organization
Organization Name:PAUL A TARANTINO, M.D.,P.A.
Other - Org Name:TARANTINO EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:TARANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-590-9260
Mailing Address - Street 1:806 LANDMARK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4980
Mailing Address - Country:US
Mailing Address - Phone:410-590-9260
Mailing Address - Fax:410-590-9266
Practice Address - Street 1:1403 MADISON PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5613
Practice Address - Country:US
Practice Address - Phone:410-590-9260
Practice Address - Fax:410-590-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD979LMedicare ID - Type Unspecified