Provider Demographics
NPI:1811154586
Name:HUSTON, TARA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:HUSTON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:HSC T19 060
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-9394
Mailing Address - Fax:631-444-6007
Practice Address - Street 1:HSC T19 060
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-9394
Practice Address - Fax:631-444-6007
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2011-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2302492086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery