Individual provider Active NPI

Tara Lynne McColgin Dutta, M.D.

  • Neurology Physician
  • York, PA
National Provider Identifier
1679700900
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD477041 Issued in PA
Practice address
1695 Roosevelt Ave Ste B
York, PA 17408-8521
Phone
(717) 851-5503
Fax
(717) 798-3510
NPI assigned
Jun 12, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X FD4884450 PA
Internal Medicine Physician 207R00000X P24030 MD
Neurology Physician 2084N0400X A127885 CA
Neurology Physician 2084N0400X MD477041 PA Primary

Addresses

Primary practice location

1695 Roosevelt Ave Ste B
York, PA 17408-8521

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405

Other practice location 1

1520 San Pablo St
Suite 3000
Los Angeles, CA 90033-5310
Phone (323) 442-5710

Other practice location 2

228 Saint Charles Way Ste 200
York, PA 17402-4661
Phone (717) 851-5503

Other identifiers 1

IdentifierTypeStateIssuer
A127885OtherCAMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171205000774 MD Practitioner - Neurology 8325260672 Reassigns benefits to 1 organization
I20221004000099 PA Practitioner - Neurology 8325260672 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Indiana University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

228 St Charles Way
Wellspan Neurology
York, PA 17402-4644
Phone (717) 851-5503

Hospital & facility affiliations

  • Wellspan York Hospital Hospital, York, PA, CCN 390046
  • Gettysburg Hospital Hospital, Gettysburg, PA, CCN 390065

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P24030MDMDInternal Medicine Physician
A127885CAMDNeurology Physician
MD477041PAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Neurology Associates, P.a. CurrentSince Oct 30, 2017 Accepting new patients
University of Maryland Neurology Associates, P.a. CurrentSince Oct 30, 2017 Accepting new patients
Wellspan Medical Group Current Accepting new patients
Wellspan Medical Group Neurology CurrentSince Oct 24, 2022 Accepting new patients
Wellspan Medical Group CurrentSince Oct 24, 2022 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Wellspan Medical Group Past Accepting new patients

Locations

22 S Greene St
Baltimore, MD 21201
Phone (410) 328-5793

16 S Eutaw St
Baltimore, MD 21201
Phone (410) 328-2864

16 S Eutaw St
Fl 3
Baltimore, MD 21201
Phone (410) 328-4448

228 Saint Charles Way
York, PA 17402
Phone (717) 812-2212

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

1600 S George St
York, PA 17403
Phone (717) 848-3615

1695 Roosevelt Ave
Ste B
York, PA 17408

601 Memory Ln
York, PA 17402
Phone (717) 851-6670

228 Saint Charles Way
Ste 200
York, PA 17402

Interoperability endpoints

  • Direct secure messaging: tdutta300493@wellspan.direct-ci.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1679700900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-851-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 ROOSEVELT AVE STE B",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174088521",
            "telephone_number": "717-851-5503",
            "fax_number": "717-798-3510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1520 San Pablo St",
            "address_2": "Suite 3000",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900335310",
            "country_code": "US",
            "telephone_number": "323-442-5710",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "228 Saint Charles Way Ste 200",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174024661",
            "country_code": "US",
            "telephone_number": "717-851-5503",
            "fax_number": "717-851-5507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUTTA",
        "first_name": "TARA",
        "middle_name": "LYNNE MCCOLGIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-12",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "FD4884450",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "P24030",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A127885",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD477041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "A127885",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in York, PA

Sources for this page

Verify at the official NPI Registry.