Provider Demographics
NPI:1003635673
Name:DONALDSON, TARA DALE (CNP)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:DALE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:723 BERWICK CT
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1494
Mailing Address - Country:US
Mailing Address - Phone:330-256-2561
Mailing Address - Fax:
Practice Address - Street 1:161 N FORGE ST STE 295
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1483
Practice Address - Country:US
Practice Address - Phone:330-379-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.037647207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology