MR. MARK TABAKA (NPI# 1457353005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457353005 |
| Entity Type | Individual |
| Full Name | MR. MARK TABAKA |
| Credential | PA-C |
| Practice Address |
576 Farmington Ave Bristol CT 06010-3933 |
| Mailing Address |
11 Arkona Dr Higganum CT 06441-4479 |
| Practice Telephone | 8605853000 |
| Mailing Telephone | 8605545021 |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2018-11-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
1803 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
576 FARMINGTON AVE |
| City | BRISTOL |
| State | CT |
| Zip Code | 06010-3933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255975330 | Urgent Care of Bristol, LLC | Clinic/Center | 576 Farmington Ave, Bristol, CT 06010-3933 | 2019-11-01 |
| 1639555469 | New England Urgent Care Enfield LLC | Clinic/Center | 576 Farmington Ave, Bristol, CT 06010-3933 | 2015-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457991309 | A New Hope Caregiving Alliance LLC | Home Health | 225 North Main Street - Suite 107, Bristol, CT 06010 | 2020-01-08 |
| 1154981777 | Georgianna Sloate Lmft, LLC | Marriage & Family Therapist | 38 Kelley Street, Bristol, CT 06010 | 2019-06-17 |
| 1962062810 | Ariel Morley | Urology | 15 Riverside Avenue, Bristol, CT 06010 | 2019-06-13 |
| 1013439488 | Theresa Rose Manolitsis | Student in an Organized Health Care Education/Training Program | 170 Pondview Lane, Bristol, CT 06010 | 2017-07-07 |
| 1588103600 | Elizabeth Anne Costello | Pharmacist | 747 Pine Street, Bristol, CT 06010 | 2017-02-22 |
| 1992157903 | Aiman Riaz | Internal Medicine | 41 Brewster Rd # 5161, Bristol, CT 06010 | 2016-07-01 |
| 1346609955 | Monika Magdalena Sullivan | Nurse Practitioner | 122 Maple Street, Bristol, CT 06010 | 2016-02-11 |
| 1346660776 | Peter Bellezza | Podiatrist | 15 Riverside Ave, Bristol, CT 06010 | 2014-04-24 |
| 1487088001 | Stephen Alexander Merwin | Social Worker | 32 Laird Drive, Bristol, CT 06010 | 2013-08-30 |
| 1215369574 | In Kyung Lee | Dentist | 1192 Farmington Ave., Bristol, CT 06010 | 2013-08-08 |
| Find all providers in zip 06010 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487724936 | Mark Steven Mehlferber | Physician Assistant | 320 Bristol West Blvd Ste 2b, Bristol, TN 37620-8765 | 2006-11-09 |
| 1124051750 | Antonio Santoro | Physician Assistant | Bristol Hospital, Brewster Rd., Bristol, CT 06011-0977 | 2006-07-08 |
| 1497265573 | Brianna Galligan | Physician Assistant | 501 Bath Rd, Bristol, PA 19007-3101 | 2017-10-03 |
| 1578087375 | Hilda M Boateng | Physician Assistant | 41 Brewster Rd, Bristol, CT 06010-5161 | 2017-08-02 |
| 1669822532 | Kristin Somerville | Physician Assistant | 22 Pine St, Bristol, CT 06010-6948 | 2016-06-21 |
| 1467801605 | Kayla Nicole Kennedy | Physician Assistant | 22 Pine St, Suite 104, Bristol, CT 06010-6948 | 2016-06-08 |
| 1447604954 | Carys Roberts | Physician Assistant | 501 Bath Rd, Bristol, PA 19007-3101 | 2016-04-20 |
| 1437565553 | Daniel P Tuohey | Physician Assistant | 539 Farmington Ave, Bristol, CT 06010-3931 | 2014-07-09 |
| 1427486380 | Jaret Williams | Physician Assistant | 539 Farmington Ave, Bristol, CT 06010-3931 | 2013-10-30 |
| 1417389735 | Richard B Ahrens Jr. | Physician Assistant | 41 Brewster Rd, Bristol, CT 06010-5161 | 2013-08-09 |
| Find all providers in BRISTOL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.