Provider Demographics
NPI:1386612687
Name:TARA, PIMPA J (MD)
Entity type:Individual
Prefix:DR
First Name:PIMPA
Middle Name:J
Last Name:TARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8127 MERRILLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6158
Mailing Address - Country:US
Mailing Address - Phone:219-769-4855
Mailing Address - Fax:
Practice Address - Street 1:8127 MERRILLVILLE RD
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6158
Practice Address - Country:US
Practice Address - Phone:219-769-4855
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031667207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E03880Medicare UPIN
IN218800FMedicare ID - Type Unspecified