Provider Demographics
NPI:1982751418
Name:RAY, TARA D (CRNA, MSN)
Entity type:Individual
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First Name:TARA
Middle Name:D
Last Name:RAY
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Gender:F
Credentials:CRNA, MSN
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Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2421
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-7977
Practice Address - Fax:215-456-3459
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-07-09
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Provider Licenses
StateLicense IDTaxonomies
PARN349865L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered