Provider Demographics
NPI:1134421001
Name:ALTEPETER, TARA A (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:A
Last Name:ALTEPETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 FOREST GLEN RD STE 335
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1479
Mailing Address - Country:US
Mailing Address - Phone:240-531-2572
Mailing Address - Fax:800-884-8618
Practice Address - Street 1:1400 FOREST GLEN RD STE 335
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1479
Practice Address - Country:US
Practice Address - Phone:240-531-2572
Practice Address - Fax:800-884-8618
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01023462080B0002X, 2083B0002X
DEC7-00050002080P0206X
IL036.126876208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity Medicine
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics