MEDICARE: DR. TARA S BUEHLER-BOTA M.D.

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	207N00000X	Dermatology Physician	0101260736	VA

General Provider Information

NPI Number	:	1396007787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA S BUEHLER-BOTA M.D.

Provider Business Mailing Address
First Line	:	6160 KEMPSVILLE CIR STE 200A
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-3945
Country	:	US
Telephone Number	:	757-622-6315
Fax Number	:	757-622-7022

Provider Business Practice Location Address
First Line	:	1248 PERIMETER PKWY STE 482
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5914
Country	:	US
Telephone Number	:	757-622-6315
Fax Number	:

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

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/24/2024

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