MEDICARE: TARA LAIR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50004547RX	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609963990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA LAIR PA-C

Provider Business Mailing Address
First Line	:	7794 FIVE MILE ROAD
Second Line	:	SUITE 240
City	:	CINCINNATI
State	:	OH
Zip	:	45230
Country	:	US
Telephone Number	:	513-231-1575
Fax Number	:	855-818-3918

Provider Business Practice Location Address
First Line	:	7794 5 MILE RD STE 240
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2372
Country	:	US
Telephone Number	:	513-231-1575
Fax Number	:	855-818-3918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	02/27/2023

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Directions to “ TARA LAIR PA-C” Practice Location

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