Provider Demographics
NPI:1457118762
Name:GRINAGE, TARA ASHLEY
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ASHLEY
Last Name:GRINAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:ASHLEY
Other - Last Name:CHANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 FENWICK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235
Mailing Address - Country:US
Mailing Address - Phone:434-882-0643
Mailing Address - Fax:
Practice Address - Street 1:1236 AMBER RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-9543
Practice Address - Country:US
Practice Address - Phone:434-806-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle