Healthcare Provider Details

I. General information

NPI: 1215249560
Provider Name (Legal Business Name): JARRED CORY ZUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ANNA MARSH LANE
BRATTLEBORO VT
05301
US

IV. Provider business mailing address

PO BOX 101
BRATTLEBORO VT
05302-0101
US

V. Phone/Fax

Practice location:
  • Phone: 802-258-3700
  • Fax: 802-258-3723
Mailing address:
  • Phone: 802-258-3700
  • Fax: 802-258-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042.0013909
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number272808
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: