Healthcare Provider Details

I. General information

NPI: 1437148475
Provider Name (Legal Business Name): MARA V VIJUPS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARA V VIJUPS M.D.

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 WASHINGTON HWY
MORRISVILLE VT
05661-8652
US

IV. Provider business mailing address

PO BOX 749
MORRISVILLE VT
05661-0749
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-5639
  • Fax: 802-888-6040
Mailing address:
  • Phone: 802-851-8704
  • Fax: 802-851-8716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420009033
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: