Provider Demographics
NPI:1396327672
Name:AVERY, TARA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:ELIZABETH
Last Name:AVERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:ELIZABETH
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE # 61-22
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-8050
Mailing Address - Fax:570-271-5940
Practice Address - Street 1:16 WOODBINE LANE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-8050
Practice Address - Fax:570-271-5940
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD490561207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology