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TARA JACKSON LEMOINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 224-4635
(540) 985-9099
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0102208200
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003111892A
GA
01
618879
WELLCARE
GA
05
GA1252
SC
01
P00999566
RAILROAD MEDICARE
GA
Enumeration date
09/26/2007
Last updated
10/19/2023
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