Provider Demographics
NPI:1962693887
Name:MARTINEZ, TARA DAWN (DO)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:DAWN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2171 JERICHO TPKE STE 100
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2900
Mailing Address - Country:US
Mailing Address - Phone:631-486-5030
Mailing Address - Fax:631-724-4229
Practice Address - Street 1:2171 JERICHO TPKE STE 100
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2900
Practice Address - Country:US
Practice Address - Phone:631-486-5030
Practice Address - Fax:631-486-2694
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2022-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY267602208600000X, 208C00000X
FLOS16564208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery