Provider Demographics
NPI:1437148475
Name:VIJUPS, MARA V (MD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:V
Last Name:VIJUPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:V
Other - Last Name:VIJUPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0749
Mailing Address - Country:US
Mailing Address - Phone:802-851-8704
Mailing Address - Fax:802-851-8716
Practice Address - Street 1:609 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8652
Practice Address - Country:US
Practice Address - Phone:802-888-5639
Practice Address - Fax:802-888-6040
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03510794Medicaid
VT0VN1317Medicaid
NYJ40082249Medicare UPIN
VT0VN1317Medicaid
NY03510794Medicaid