Provider Demographics
NPI:1992700751
Name:SHIPMAN, TARA A (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:A
Last Name:SHIPMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 DEBARTOLO PL STE 200
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6095
Mailing Address - Country:US
Mailing Address - Phone:330-729-8146
Mailing Address - Fax:330-965-5229
Practice Address - Street 1:1651 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6600
Practice Address - Country:US
Practice Address - Phone:330-394-4900
Practice Address - Fax:330-394-6900
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.072324207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2144549Medicaid
OH2144549Medicaid
OHG94463Medicare UPIN
OH0878002Medicare PIN