Basic Information
| Provider Information | |||||||||
| NPI: | 1962478909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TARAS | ||||||||
| FirstName: | MALGORZATA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 580 SAINT JOHNSBURY RD | ||||||||
| Address2: | NORTH COUNTRY INTERNAL MEDICINE | ||||||||
| City: | LITTLETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035613437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034440116 | ||||||||
| FaxNumber: | 6034442769 | ||||||||
| Practice Location | |||||||||
| Address1: | 580 SAINT JOHNSBURY RD | ||||||||
| Address2: | NORTH COUNTRY INTERNAL MEDICINE | ||||||||
| City: | LITTLETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035613437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034440116 | ||||||||
| FaxNumber: | 6034442769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 12633 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 48137 | 01 | VT | BLUE CROSS/BLUE SHIELD | OTHER | 3279001 | 01 | NH | CIGNA HEALTHCARE | OTHER | 1006088 | 05 | VT | MEDICAID | 80300008 | 05 | NH | MEDICAID |