Tara Jo Trout, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA052621 Issued in PA

Practice address

1701 Cornwall Rd
Suite 101
Lebanon, PA 17042-7480

Phone

(717) 675-1788

Fax

(717) 675-1800

NPI assigned

Aug 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1801803432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 CORNWALL RD",
            "address_2": "SUITE 101",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427480",
            "telephone_number": "717-675-1788",
            "fax_number": "717-675-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CORNWALL RD",
            "address_2": "SUITE 101",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427480",
            "telephone_number": "717-675-1788",
            "fax_number": "717-675-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TROUT",
        "first_name": "TARA",
        "middle_name": "JO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA052621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICEN",
            "identifier": "MA052621",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.