MEDICARE: DR. MARY ANN YEATTS-PETERSON M.D.

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
1	207V00000X	Obstetrics & Gynecology Physician	0420009181	VT

General Provider Information

NPI Number	:	1720036437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANN YEATTS-PETERSON M.D.

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	:	802-527-7701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	06/03/2021

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