Healthcare Provider Details

I. General information

NPI: 1033378948
Provider Name (Legal Business Name): SANDRA L MARUSZAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HIGHLAND STREET LAKES REGION GENERAL HOSPITAL
LACONIA NH
03246-3235
US

IV. Provider business mailing address

PO BOX 678
LACONIA NH
03247-0678
US

V. Phone/Fax

Practice location:
  • Phone: 603-527-2819
  • Fax: 603-527-2984
Mailing address:
  • Phone: 603-524-3211
  • Fax: 603-527-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number14715
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: