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General NPI Number Information
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NPI Number | 1790306926
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Entity Type | Individual
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Provider Name | MOHAMMED ROSHAD TARR MD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 1601 2ND ST STE 108
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2701
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Country | US
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Telephone | 415-456-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 6019 WALNUT GROVE RD
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City | MEMPHIS
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State | TN
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Zip | 38120-2113
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Country | US
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Telephone | 902-226-1358
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 34228
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | A199049
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License Number State | CA
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