Provider Demographics
NPI:1649253360
Name:STATON, TARA M (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:M
Last Name:STATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9428
Mailing Address - Country:US
Mailing Address - Phone:919-734-1779
Mailing Address - Fax:
Practice Address - Street 1:2609 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9428
Practice Address - Country:US
Practice Address - Phone:919-734-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000001902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134VYMedicaid
NCP00314273OtherRAILROAD MEDICARE
NC188452OtherMEDCOST
NC134VYOtherBCBS NC
NC8565117OtherCIGNA HEALTHCARE
NC188452OtherMEDCOST
NCP00314273OtherRAILROAD MEDICARE