Provider Demographics
NPI:1518956150
Name:CATANZANO, TARA MARIE (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:CATANZANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HSC LEVEL 4, ROOM 120
Mailing Address - Street 2:101 NICOLLS ROAD
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8460
Mailing Address - Country:US
Mailing Address - Phone:631-444-7955
Mailing Address - Fax:631-444-7538
Practice Address - Street 1:101 NICOLLS ROAD
Practice Address - Street 2:HSC LEVEL 4, ROOM 120
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8460
Practice Address - Country:US
Practice Address - Phone:631-444-5400
Practice Address - Fax:631-444-7538
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0397882085R0202X
NY3336792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001397886Medicaid
CT300003292Medicare ID - Type Unspecified
H60561Medicare UPIN