Healthcare Provider Details

I. General information

NPI: 1457779100
Provider Name (Legal Business Name): TARA NIKONOW MORGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA NICOLE NIKONOW M.D.

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 WAKE FOREST RD STE 506
RALEIGH NC
27609-7376
US

IV. Provider business mailing address

3471 5TH AVE STE 700
PITTSBURGH PA
15213-3232
US

V. Phone/Fax

Practice location:
  • Phone: 724-244-6789
  • Fax:
Mailing address:
  • Phone: 412-692-4091
  • Fax: 412-692-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMT206574
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2021-01395
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: