Provider Demographics
NPI:1871627794
Name:MARA VIJUPS, MD PC
Entity type:Organization
Organization Name:MARA VIJUPS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIJUPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-524-6333
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-1332
Mailing Address - Country:US
Mailing Address - Phone:802-524-8950
Mailing Address - Fax:802-524-7021
Practice Address - Street 1:10 CREST RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9701
Practice Address - Country:US
Practice Address - Phone:802-524-6333
Practice Address - Fax:802-524-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1317Medicaid
VT0VN1317Medicaid