Provider Demographics
NPI:1851856504
Name:TAREEN DERMATOLOGY, PA
Entity Type:Organization
Organization Name:TAREEN DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHIBA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-633-6883
Mailing Address - Street 1:1835 COUNTY ROAD C W STE 250
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1311
Mailing Address - Country:US
Mailing Address - Phone:651-251-3300
Mailing Address - Fax:651-528-6276
Practice Address - Street 1:2945 HAZELWOOD ST STE 230
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1241
Practice Address - Country:US
Practice Address - Phone:651-633-6883
Practice Address - Fax:651-528-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site