Provider Demographics
NPI:1023271913
Name:TARABOLOUS, CHAD JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JACOB
Last Name:TARABOLOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:SUITE 19
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2880
Practice Address - Country:US
Practice Address - Phone:606-325-2221
Practice Address - Fax:606-324-1326
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT193645207R00000X
KY47626207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine