Provider Demographics
NPI:1558756866
Name:MARCZAK, TARA D (DO)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:D
Last Name:MARCZAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 CONCORD AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1055
Mailing Address - Country:US
Mailing Address - Phone:617-354-5452
Mailing Address - Fax:617-354-0458
Practice Address - Street 1:725 CONCORD AVE STE 1200
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1055
Practice Address - Country:US
Practice Address - Phone:617-354-5452
Practice Address - Fax:617-354-0458
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program