Healthcare Provider Details

I. General information

NPI: 1558756866
Provider Name (Legal Business Name): TARA D MARCZAK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WALL ST
BURLINGTON MA
01803-4758
US

IV. Provider business mailing address

20 WALL ST
BURLINGTON MA
01803-4758
US

V. Phone/Fax

Practice location:
  • Phone: 781-221-2940
  • Fax:
Mailing address:
  • Phone: 781-221-2940
  • Fax: 781-221-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number277748
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: