Ray, Tara Fawn
Ray, Tara Fawn is an sole proprietor health care provider with primary practice located at 400 Division St Suite 3, South Charleston WV 25309-1459. She recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as her primary health care specialty. Ray, Tara Fawn can be contacted via phone (304) 767-7960.Contact Information
Primary practice address
400 Division St Suite 3
South Charleston WV 25309-1459
Phone: (304) 767-7960
Fax: (304) 767-7969
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 2117 | West Virginia |
Profile Details
| NPI number | 1033152418 |
|---|---|
| LBN Legal business name | Ray, Tara Fawn |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 14th, 2006 |
| Last updated | May 17th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1033152418 | NPPES |
| West Virginia | MEDICAID | 3810002665 | |
| West Virginia | Other | 208724900 | |
| West Virginia | Other | 2616995 |
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