Basic Information
| Provider Information | |||||||||
| NPI: | 1083844302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TUTWILER | ||||||||
| OtherFirstName: | TARA | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5500 MAIN ST | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142216755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162043200 | ||||||||
| FaxNumber: | 7162044061 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 FARBER HALL | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142148001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168292070 | ||||||||
| FaxNumber: | 7168292138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 12/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 013298 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.