Individual
TARA MARIE FRYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
78 OMEGA DR BLDG C, NEWARK, DE 19713-2064
(302) 368-2883
(302) 368-2892
Mailing address
78 OMEGA DR BLDG C, NEWARK, DE 19713-2064
(302) 368-2883
(302) 368-2892
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
C5-0011410
DE
363AM0700X
Medical Physician Assistant
Primary
C50011410
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C50011410
STATE LICENSE
DE
Enumeration date
07/06/2020
Last updated
11/16/2020
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