Individual
DR. TARA GOODLETT GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
311 CODDLE MARKET DR NW, STE 100, CONCORD, NC 28027
(980) 302-9100
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
200200525
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1200893
UNITED HEALTHCARE
NC
01
—
13114
BCBS
NC
01
—
280247
MAMSI
NC
01
—
2943796
AETNA
NC
01
—
800286
PARTNERS MCR CHOICE
NC
05
—
8913114
—
NC
01
—
B6712
MEDCOST
NC
Enumeration date
01/26/2006
Last updated
06/15/2023
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