Healthcare Provider Details

I. General information

NPI: 1487965315
Provider Name (Legal Business Name): TARA JONES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 STATE HIGHWAY 28
RICHFIELD SPRINGS NY
13439-4830
US

IV. Provider business mailing address

1123 COUNTY HIGHWAY 26
FLY CREEK NY
13337-2703
US

V. Phone/Fax

Practice location:
  • Phone: 315-858-0040
  • Fax: 315-858-0075
Mailing address:
  • Phone: 607-779-8698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number275577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: