Provider Demographics
NPI:1194804047
Name:SEMCHYSHYN, TARAS
Entity type:Individual
Prefix:DR
First Name:TARAS
Middle Name:
Last Name:SEMCHYSHYN
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 1:2025 FRONTIS PLAZA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5663
Mailing Address - Country:US
Mailing Address - Phone:336-768-3240
Mailing Address - Fax:
Practice Address - Street 1:2025 FRONTIS PLAZA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5663
Practice Address - Country:US
Practice Address - Phone:336-768-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131NHMedicaid
NC89131NHMedicaid
NC2001780Medicare PIN