Healthcare Provider Details

I. General information

NPI: 1205836863
Provider Name (Legal Business Name): ERIC STEVEN SEYFERTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HOSPITAL DR SUITE 310
BENNINGTON VT
05201-5018
US

IV. Provider business mailing address

140 HOSPITAL DR SUITE 310
BENNINGTON VT
05201-5018
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-7855
  • Fax: 802-442-6638
Mailing address:
  • Phone: 802-442-7855
  • Fax: 802-442-6638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042-0007982
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: