Basic Information
Provider Information | |||||||||
NPI: | 1093710170 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEMAIRE | ||||||||
FirstName: | TARA | ||||||||
MiddleName: | SPAIN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 751 STEWART ROAD | ||||||||
Address2: |   | ||||||||
City: | SPARTA | ||||||||
State: | TN | ||||||||
PostalCode: | 38583 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9312561038 | ||||||||
FaxNumber: | 9316147517 | ||||||||
Practice Location | |||||||||
Address1: | 1070 OLD NATIONAL PIKE ROAD | ||||||||
Address2: |   | ||||||||
City: | FREDERICKTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 153332114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7246326801 | ||||||||
FaxNumber: | 7246326312 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/16/2005 | ||||||||
LastUpdateDate: | 11/19/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/19/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0000030396 | TN | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.