Provider Demographics
NPI:1427324888
Name:KIMBASON, TARA (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:KIMBASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:301 RIVERVIEW AVE STE 202A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9015
Mailing Address - Fax:757-510-9041
Practice Address - Street 1:301 RIVERVIEW AVE STE 202A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9015
Practice Address - Fax:757-510-9041
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01087262A2084N0400X
FLME1374572084N0400X
VA01012608122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology