Provider Demographics
NPI:1962453761
Name:TALWAR, TARA (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:TALWAR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11144 TESSON FERRY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6965
Mailing Address - Country:US
Mailing Address - Phone:314-842-4181
Mailing Address - Fax:314-842-4833
Practice Address - Street 1:11144 TESSON FERRY RD
Practice Address - Street 2:STE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6965
Practice Address - Country:US
Practice Address - Phone:314-842-4181
Practice Address - Fax:314-842-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2017-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7F13207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202822516Medicaid
MO156440101OtherMEDICARE PTAN #
MO202822516Medicaid