Provider Demographics
NPI:1780266395
Name:MCELROY, TARA CLARE (DPM, MPH)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:CLARE
Last Name:MCELROY
Suffix:
Gender:F
Credentials:DPM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-765-0710
Mailing Address - Fax:336-765-0821
Practice Address - Street 1:3057 TRENWEST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3220
Practice Address - Country:US
Practice Address - Phone:336-765-0710
Practice Address - Fax:336-765-0821
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program