Provider Demographics
NPI:1700998051
Name:ASSI, TARA L (PA-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:ASSI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:L
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-3110
Mailing Address - Fax:717-339-3108
Practice Address - Street 1:450 S WASHINGTON ST
Practice Address - Street 2:3RD FLOOR SUITE C
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2500
Practice Address - Country:US
Practice Address - Phone:717-339-3110
Practice Address - Fax:717-339-3108
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051248363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1545319OtherGATEWAY-WMG
PA0019753370001Medicaid
PA2016748OtherHIGHMARK BLUE SHIELD
PA1545319OtherGATEWAY-WMG
083223S5VMedicare ID - Type Unspecified
PA0019753370001Medicaid
PA2016748OtherHIGHMARK BLUE SHIELD