Healthcare Provider Details

I. General information

NPI: 1831813302
Provider Name (Legal Business Name): TARA GOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 ERICKSON AVE
ESSINGTON PA
19029-1506
US

IV. Provider business mailing address

244 ERICKSON AVE
ESSINGTON PA
19029-1506
US

V. Phone/Fax

Practice location:
  • Phone: 610-306-6314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-302767
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierL-302767
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerIBCLC CREDENTIAL NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: