Provider Demographics
NPI:1841448925
Name:PIETROBONO, TARA SUSANNE (DPM)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:SUSANNE
Last Name:PIETROBONO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CREEKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4839
Mailing Address - Country:US
Mailing Address - Phone:864-252-4889
Mailing Address - Fax:
Practice Address - Street 1:1 CREEKVIEW CT STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4839
Practice Address - Country:US
Practice Address - Phone:864-252-4889
Practice Address - Fax:864-252-4254
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC577213ES0103X
SCHAS0534237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU86689Medicare UPIN