Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 023754 | CT |
N | 207RG0300X | Geriatric Medicine | 023754 | CT |
NPI | 1144331521 |
---|---|
Provider Name | Dr. David Mark Taraskevich |
First Address | Meriden, CT 06450-4407 |
Second Address | Meriden, CT 06450-4407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 22/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B84638 | (02) | CT |