Provider Demographics
NPI:1184757833
Name:DAVID M TARASKEVICH MD
Entity type:Organization
Organization Name:DAVID M TARASKEVICH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:TARASKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-237-2200
Mailing Address - Street 1:237 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4407
Mailing Address - Country:US
Mailing Address - Phone:203-237-2200
Mailing Address - Fax:203-630-0655
Practice Address - Street 1:237 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4407
Practice Address - Country:US
Practice Address - Phone:203-237-2200
Practice Address - Fax:203-630-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB84638Medicare UPIN
CTC00954Medicare PIN