Healthcare Provider Details

I. General information

NPI: 1912947342
Provider Name (Legal Business Name): HAROLD TARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL STREET SUITE A
NEW HAVEN CT
06511
US

IV. Provider business mailing address

19 LUNAR DRIVE
WOODBRIDGE CT
06525
US

V. Phone/Fax

Practice location:
  • Phone: 203-867-5420
  • Fax: 203-867-5422
Mailing address:
  • Phone: 203-389-7504
  • Fax: 203-389-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036991
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036991
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: