Provider Demographics
NPI:1245355155
Name:BELSARE, TARA J (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:BELSARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHUBHADA
Other - Middle Name:JAYANT
Other - Last Name:BELSARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 CRARY AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-3829
Mailing Address - Country:US
Mailing Address - Phone:607-624-1775
Mailing Address - Fax:607-203-1668
Practice Address - Street 1:3220 PEARL ST
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-5758
Practice Address - Country:US
Practice Address - Phone:607-215-1705
Practice Address - Fax:607-304-2374
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2236562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY223656Medicaid
NYH15464Medicare UPIN