Provider Demographics
NPI:1821287855
Name:KARP, TARA F (DO)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:F
Last Name:KARP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:325 POSADA LN
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4003
Practice Address - Country:US
Practice Address - Phone:805-542-6703
Practice Address - Fax:805-542-6791
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11135208000000X
FLUO1770390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71074FMedicaid
HAP71074FOtherSOFP
CA051013Medicare Oscar/Certification
HAP71074FOtherSOFP
CAPTAN DR948ZMedicare PIN
CAGROUP PTAN W1508Medicare PIN
CAW1508BMedicare PIN