Provider Demographics
NPI:1346665668
Name:CONROY, TARA (PA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CONROY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-775-0000
Mailing Address - Fax:603-778-2491
Practice Address - Street 1:20 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4823
Practice Address - Country:US
Practice Address - Phone:603-775-0000
Practice Address - Fax:603-778-2491
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1019363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3096380Medicaid
NHT400155628Medicare PIN