Healthcare Provider Details

I. General information

NPI: 1265542211
Provider Name (Legal Business Name): SUSAN SUTPHEN SLOWINSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 ATKINSON ST CORNERSTONE PEDIATRICS
BELLOWS FALLS VT
05101-1326
US

IV. Provider business mailing address

128 ATKINSON ST CORNERSTONE PEDIATRICS
BELLOWS FALLS VT
05101-1326
US

V. Phone/Fax

Practice location:
  • Phone: 802-463-2020
  • Fax: 802-463-1195
Mailing address:
  • Phone: 802-463-2020
  • Fax: 802-463-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420009630
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: