MEDICARE: DR. TARA A ALTEPETER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080B0002X	Pediatric Obesity Medicine Physician	D0102346	MD
2	2080P0206X	Pediatric Gastroenterology Physician	C7-0005000	DE
3	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	D0102346	MD
4	208000000X	Pediatrics Physician	036.126876	IL

General Provider Information

NPI Number	:	1134421001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA A ALTEPETER MD

Provider Business Mailing Address
First Line	:	1400 FOREST GLEN RD STE 335
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1479
Country	:	US
Telephone Number	:	240-531-2572
Fax Number	:	800-884-8618

Provider Business Practice Location Address
First Line	:	1400 FOREST GLEN RD STE 335
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1479
Country	:	US
Telephone Number	:	240-531-2572
Fax Number	:	800-884-8618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	11/05/2025

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