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NPI Code Detail

MEDICARE: MARY ANN YEATTS-PETERSON,MD,LLC

MEDICARE: MARY ANN YEATTS-PETERSON,MD,LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician0420009181VT

General Provider Information

NPI Number : 1225449184
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARY ANN YEATTS-PETERSON,MD,LLC
Provider Business Mailing Address
First Line : 37 CATHERINE ST
Second Line :
City : SAINT ALBANS
State : VT
Zip : 05478-2205
Country : US
Telephone Number : 802-527-7717
Fax Number : 802-527-7701
Provider Business Practice Location Address
First Line : 37 CATHERINE ST
Second Line :
City : SAINT ALBANS
State : VT
Zip : 05478-2205
Country : US
Telephone Number : 802-527-7717
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MARY ANN YEATTS-PETERSON
Credential : MD
Telephone Number : 802-527-7717
Provider Enumeration Date : 05/14/2014
Last Update Date : 05/14/2014

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