Provider Demographics
NPI:1295763670
Name:REIMER, TARA LYN (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYN
Last Name:REIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24 CARROW ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2604
Mailing Address - Country:US
Mailing Address - Phone:716-662-3443
Mailing Address - Fax:716-972-0374
Practice Address - Street 1:24 CARROW ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2604
Practice Address - Country:US
Practice Address - Phone:716-662-3443
Practice Address - Fax:716-972-0374
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2319122080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000527699001OtherBLUE CROSS/BLUE SHIELD (HEALTH NOW)
NY1212532OtherINDEPENDENT HEALTH ASSOCIATION
NY00026878601OtherUNIVERA HEALTHCARE
NY02563968Medicaid