Provider Demographics
NPI:1134400310
Name:VILK, TARA POUSLAND (MA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:POUSLAND
Last Name:VILK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BELLVISTA RD
Mailing Address - Street 2:APARTMENT 6
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7612
Mailing Address - Country:US
Mailing Address - Phone:774-274-8873
Mailing Address - Fax:
Practice Address - Street 1:12 HARRIET ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2119
Practice Address - Country:US
Practice Address - Phone:774-274-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program