MEDICARE: MARA V VIJUPS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0420009033	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437148475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA V VIJUPS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 749
Second Line	:
City	:	MORRISVILLE
State	:	VT
Zip	:	05661-0749
Country	:	US
Telephone Number	:	802-851-8704
Fax Number	:	802-851-8716

Provider Business Practice Location Address
First Line	:	609 WASHINGTON HWY
Second Line	:
City	:	MORRISVILLE
State	:	VT
Zip	:	05661-8652
Country	:	US
Telephone Number	:	802-888-5639
Fax Number	:	802-888-6040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	11/17/2021

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