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General NPI Number Information
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NPI Number | 1427324888
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Entity Type | Individual
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Provider Name | TARA KIMBASON M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 301 RIVERVIEW AVE STE 202A
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City | NORFOLK
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State | VA
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Zip | 23510-1065
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Country | US
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Telephone | 757-252-9015
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Fax | 757-510-9041
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Provider Business Mailing Address
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Address Line | 301 RIVERVIEW AVE STE 202A
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City | NORFOLK
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State | VA
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Zip | 23510-1065
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Country | US
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Telephone | 757-252-9015
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Fax | 757-510-9041
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01087262A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME137457
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0101260812
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License Number State | VA
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