MEDICARE: EZZA FATIMA TARIQ MD

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	208M00000X	Hospitalist Physician	01097794A	IN
2	207R00000X	Internal Medicine Physician	MD486005	PA
3	207R00000X	Internal Medicine Physician	01097794A	IN

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

General Provider Information

NPI Number	:	1689253007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZZA FATIMA TARIQ MD

Provider Business Mailing Address
First Line	:	3245 HEALTH DR STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:	574-647-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 HOSPITAL RD
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3629
Country	:	US
Telephone Number	:	724-357-7000
Fax Number	:

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

Provider Enumeration Date	:	04/04/2021
Last Update Date	:	03/30/2026

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Directions to “ EZZA FATIMA TARIQ MD” Practice Location

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