Provider Demographics
NPI:1730402025
Name:TACK, DINA K (MD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:K
Last Name:TACK
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:PO BOX 4540
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-4540
Mailing Address - Country:US
Mailing Address - Phone:775-882-0430
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:1535 MEDICAL CENTER PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4367
Practice Address - Country:US
Practice Address - Phone:775-445-7960
Practice Address - Fax:775-883-3395
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13333207RX0202X
NV1333207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDB930YMedicare PIN