Healthcare Provider Details

I. General information

NPI: 1386639466
Provider Name (Legal Business Name): BARRY STEVEN TATAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8178 LARK BROWN RD. SUITE 101
ELKRIDGE MD
21075-6438
US

IV. Provider business mailing address

8178 LARK BROWN RD. SUITE 101
ELKRIDGE MD
21075-6438
US

V. Phone/Fax

Practice location:
  • Phone: 410-799-3940
  • Fax: 410-799-3944
Mailing address:
  • Phone: 410-799-3940
  • Fax: 410-799-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0033303
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD33303
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0033303
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: