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General NPI Number Information
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NPI Number | 1801039516
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Entity Type | Individual
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Provider Name | TARA RAMACHANDRA MD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 845 N NEW BALLAS CT STE 310
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City | CREVE COEUR
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State | MO
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Zip | 63141-7169
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Country | US
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Telephone | 314-934-0551
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Fax | 314-936-4951
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Provider Business Mailing Address
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Address Line | 845 N NEW BALLAS CT STE 310
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City | CREVE COEUR
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State | MO
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Zip | 63141-7169
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Country | US
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Telephone | 314-934-0551
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Fax | 314-936-4951
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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 | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 2016027976
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License Number State | MO
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