Individual provider · Type 1 NPI

Tara Andrea Providence, MD

Student in an Organized Health Care Education/Training Program · Buffalo, NY

NPI number 1942697792 Active

Practice location

462 Grider St., David K. Miller Bldg.
Buffalo, NY 14215

Call (716) 898-4578 Map

Fax (716) 898-3279

Mailing address

462 Grider St, David K. Miller Bldg.
Buffalo, NY 14215

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1942697792

Tara Andrea Providence, MD's National Provider Identifier is 1942697792, issued on Apr 20, 2015. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Buffalo, NY. The record was last updated on Sep 23, 2015.