Provider Demographics
NPI:1700101458
Name:KINRA, TARA DANIELLE (MD)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:DANIELLE
Last Name:KINRA
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 1:4580 PENBROOK COURT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2159
Mailing Address - Country:US
Mailing Address - Phone:214-402-1673
Mailing Address - Fax:
Practice Address - Street 1:4417 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2319
Practice Address - Country:US
Practice Address - Phone:215-302-3150
Practice Address - Fax:215-807-8951
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics