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1457353005
MARK TABAKA
BRISTOL, CT
NPI
1457353005
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: CT 1803)
Enumeration Date
2005-08-12
Last Update Date
2018-11-05
Business Address
Mr. MARK TABAKA PA-C
576 FARMINGTON AVE
BRISTOL, CT 06010-3933
Phone number: 860-585-3000
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Mailing Address
Mr. MARK TABAKA PA-C
11 ARKONA DR
HIGGANUM, CT 06441-4479
Phone number: 860-554-5021
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