Provider Demographics
NPI:1891916516
Name:COOLEY, TARA CREIGHTON (MD)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:CREIGHTON
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:STE. 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7513
Mailing Address - Country:US
Mailing Address - Phone:919-781-5510
Mailing Address - Fax:919-781-5053
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:STE.300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-781-5510
Practice Address - Fax:919-781-5053
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-0000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty