Provider Demographics
NPI:1891713699
Name:COLE, TARA J (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:COLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-268-3380
Mailing Address - Fax:336-268-3381
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-268-3380
Practice Address - Fax:336-268-3381
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200600807207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1426WOtherBCBS OF NC
NC190447OtherMEDCOST
NC5904427Medicaid
NC190447OtherMEDCOST