MEDICARE: DR. TARA RAMACHANDRA 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	207YS0123X	Facial Plastic Surgery Physician	2016027976	MO

General Provider Information

NPI Number	:	1801039516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA RAMACHANDRA MD

Provider Business Mailing Address
First Line	:	845 N NEW BALLAS CT STE 310
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7169
Country	:	US
Telephone Number	:	314-934-0551
Fax Number	:	314-936-4951

Provider Business Practice Location Address
First Line	:	845 N NEW BALLAS CT STE 310
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7169
Country	:	US
Telephone Number	:	314-934-0551
Fax Number	:	314-936-4951

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

Provider Enumeration Date	:	04/10/2009
Last Update Date	:	09/11/2025

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