Healthcare Provider Details

I. General information

NPI: 1700101458
Provider Name (Legal Business Name): TARA DANIELLE KINRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 N 6TH ST
PHILADELPHIA PA
19140-2319
US

IV. Provider business mailing address

4580 PENBROOK COURT
PLANO TX
75024-2159
US

V. Phone/Fax

Practice location:
  • Phone: 215-302-3150
  • Fax: 215-807-8951
Mailing address:
  • Phone: 214-402-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD448532
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: