Provider Demographics
NPI:1194730887
Name:BEEHARRY, TARIQ
Entity type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:BEEHARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00028061601OtherUNIVERA
PA1563203OtherGATEWAY
OH2674726Medicaid
PA411838OtherUPMC
PA218743OtherUNISON
PA1019336800001Medicaid
WV1071749OtherWEST VIRGINIA WORKERS COMP
PA1602232OtherAETNA
NY02880862Medicaid
PAP00396193OtherRR MEDICARE
PA1966966OtherBLUE SHIELD
PA411838OtherUPMC
PA1966966OtherBLUE SHIELD