Provider Demographics
NPI:1912947342
Name:TARA, HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:TARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LUNAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525
Mailing Address - Country:US
Mailing Address - Phone:203-389-7504
Mailing Address - Fax:203-389-1666
Practice Address - Street 1:1450 CHAPEL STREET
Practice Address - Street 2:SUITE A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-867-5420
Practice Address - Fax:203-867-5422
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036991207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001369918Medicaid
CT001369918Medicaid
CT830000194Medicare PIN
CT830000108Medicare ID - Type Unspecified