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General NPI Number Information
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NPI Number | 1144331521
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Entity Type | Individual
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Provider Name | DAVID MARK TARASKEVICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 237 LIBERTY ST
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City | MERIDEN
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State | CT
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Zip | 06450-4407
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Country | US
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Telephone | 203-237-2200
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Fax | 203-630-0655
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Provider Business Mailing Address
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Address Line | 237 LIBERTY ST
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City | MERIDEN
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State | CT
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Zip | 06450-4407
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Country | US
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Telephone | 203-237-2200
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Fax | 203-630-0655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 023754
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 023754
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License Number State | CT
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