Provider Demographics
NPI:1962090001
Name:RICHARD A MARASA MD PC
Entity type:Organization
Organization Name:RICHARD A MARASA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-356-0255
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156
Mailing Address - Country:US
Mailing Address - Phone:802-356-0255
Mailing Address - Fax:804-612-5201
Practice Address - Street 1:100 CUMMINGS CTR STE 428C
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6122
Practice Address - Country:US
Practice Address - Phone:800-270-2302
Practice Address - Fax:978-852-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH15037OtherMEDICAL LICENSE
MA282042OtherMEDICAL LICENSE
MAPENDINGMedicaid
NH3079550Medicaid