Individual
TARA ANN CANCELLARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
29 N ACADEMY ST, GREENVILLE, SC 29601-2629
(864) 331-1300
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8617
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
23347
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T75335
—
SC
Enumeration date
07/07/2006
Last updated
05/23/2021
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