MEDICARE: TARA GOLDEN MD, MPH

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	2083P0901X	Public Health & General Preventive Medicine Physician	MD2024-0912	NM
2	174H00000X	Health Educator

General Provider Information

NPI Number	:	1720607930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA GOLDEN MD, MPH

Provider Business Mailing Address
First Line	:	5300 HOMESTEAD RD NE STE 100
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-9001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 HOMESTEAD RD NE STE 100
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-9001
Country	:	US
Telephone Number	:	505-637-1522
Fax Number	:

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

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	02/07/2025

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