Healthcare Provider Details

I. General information

NPI: 1508167867
Provider Name (Legal Business Name): TARA J. ROBINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA J CHESTNUT P.A.

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WASHINGTON ST W STE 101
CHARLESTON WV
25302-2344
US

IV. Provider business mailing address

108 WASHINGTON ST W STE 101
CHARLESTON WV
25302-2344
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-4525
  • Fax: 304-345-4527
Mailing address:
  • Phone: 304-345-4525
  • Fax: 304-345-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number1077
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1077
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: