Provider Demographics
NPI:1679700900
Name:DUTTA, TARA LYNNE MCCOLGIN (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNNE MCCOLGIN
Last Name:DUTTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:1695 ROOSEVELT AVE STE B
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8521
Practice Address - Country:US
Practice Address - Phone:717-851-5503
Practice Address - Fax:717-798-3510
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFD48844502084N0400X
MDP24030207R00000X
CAA1278852084N0400X
PAMD4770412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA127885OtherMEDICAL LICENSE