Provider Demographics
NPI:1265052443
Name:CHASARA, TANYARADZWA TERRENCE (MD)
Entity type:Individual
Prefix:MR
First Name:TANYARADZWA
Middle Name:TERRENCE
Last Name:CHASARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:82-68 164TH ST
Mailing Address - Street 2:QUEENS HOSPITAL, DEPT OF OB/GYN, ATTN: MARILYN JOHNSON
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:214-609-0439
Mailing Address - Fax:
Practice Address - Street 1:18300 US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2206
Practice Address - Country:US
Practice Address - Phone:864-908-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA198526207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics