Provider Demographics
NPI:1962478909
Name:TARAS, MALGORZATA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:MARIA
Last Name:TARAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 SAINT JOHNSBURY RD
Mailing Address - Street 2:NORTH COUNTRY INTERNAL MEDICINE
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-3437
Mailing Address - Country:US
Mailing Address - Phone:603-444-0116
Mailing Address - Fax:603-444-2769
Practice Address - Street 1:580 SAINT JOHNSBURY RD
Practice Address - Street 2:NORTH COUNTRY INTERNAL MEDICINE
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3437
Practice Address - Country:US
Practice Address - Phone:603-444-0116
Practice Address - Fax:603-444-2769
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT48137OtherBLUE CROSS/BLUE SHIELD
NH3279001OtherCIGNA HEALTHCARE
VT1006088Medicaid
NH80300008Medicaid
NH80300008Medicaid
VT1006088Medicaid