Provider Demographics
NPI:1831343581
Name:LAFORGE, TARA MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:LAFORGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MICHELLE
Other - Last Name:BARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:306 S NEW ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1652
Mailing Address - Country:US
Mailing Address - Phone:484-426-2600
Mailing Address - Fax:833-816-7512
Practice Address - Street 1:306 S NEW ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1652
Practice Address - Country:US
Practice Address - Phone:484-426-2600
Practice Address - Fax:833-816-7512
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2606363AM0700X
NY015608-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical