Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT193645 | PA |
N | 111NI0900X | Internist | MT193645 | PA |
Y | 207RH0003X | Hematology & Oncology | 47626 | KY |
NPI | 1023271913 |
---|---|
Provider Name | Dr. Chad Jacob Tarabolous |
First Address | Ashland, KY 41105-2379 |
Second Address | Ashland, KY 41101-2880 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 07/01/2016 |