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General NPI Number Information
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NPI Number | 1487151296
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Entity Type | Individual
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Provider Name | TARA NEARY MD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 76 NEW BRITAIN AVE
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City | HARTFORD
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State | CT
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Zip | 06106-3305
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Country | US
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Telephone | 860-545-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 19 GRAND ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-2705
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Country | US
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Telephone | 860-347-6971
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | PENDING
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 79658
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License Number State | CT
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