Provider Demographics
NPI:1972769248
Name:PETROSKI, TARA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:MARIE
Last Name:PETROSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTLAND AVE # 304
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3095
Mailing Address - Country:US
Mailing Address - Phone:585-922-0866
Mailing Address - Fax:585-922-2951
Practice Address - Street 1:1425 PORTLAND AVE # 304
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-922-0866
Practice Address - Fax:585-922-2951
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253763-1208000000X
NY2537632080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics