Healthcare Provider Details

I. General information

NPI: 1437197027
Provider Name (Legal Business Name): TARA M EASLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W BELVEDERE AVE STE 508
BALTIMORE MD
21215-5232
US

IV. Provider business mailing address

2411 W BELVEDERE AVE STE 508
BALTIMORE MD
21215-5232
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-8383
  • Fax:
Mailing address:
  • Phone: 410-601-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38496
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: