Individual
TACHIRA TAVAREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-5000
Mailing address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-5000
Taxonomy
Speciality
Code
Description
License number
State
2084A2900X
Neurocritical Care Physician
01087511A
IN
2084A2900X
Neurocritical Care Physician
Primary
MD21128
RI
2084N0400X
Neurology Physician
01087511A
IN
2084N0400X
Neurology Physician
104233
GA
2084N0400X
Neurology Physician
1271189
ID
2084N0400X
Neurology Physician
D92054
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540857
MEDICARE PTAN
IN
05
—
300063167
—
IN
01
—
D92054
LICENSE
MD
Enumeration date
06/26/2013
Last updated
05/12/2026
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