Provider Demographics
NPI:1063917482
Name:MAGGE, TARA LAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LAKSHMI
Last Name:MAGGE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 BEANER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9722
Mailing Address - Country:US
Mailing Address - Phone:724-774-0778
Mailing Address - Fax:
Practice Address - Street 1:1030 BEANER HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9722
Practice Address - Country:US
Practice Address - Phone:724-774-0778
Practice Address - Fax:724-774-1109
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.141912207R00000X
390200000X
PAMD489098207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program