Healthcare Provider Details

I. General information

NPI: 1043289739
Provider Name (Legal Business Name): TARANEH AZAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MANCHESTER SQ STE 210
PORTSMOUTH NH
03801-7905
US

IV. Provider business mailing address

35 WALKER ST STE 200
KITTERY ME
03904-1727
US

V. Phone/Fax

Practice location:
  • Phone: 207-475-0100
  • Fax:
Mailing address:
  • Phone: 207-475-0100
  • Fax: 207-351-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD22343
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number11236
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: