Healthcare Provider Details

I. General information

NPI: 1285892299
Provider Name (Legal Business Name): NATASHA ALEXA WITHERS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 PINE ST STE 400
BRISTOL VT
05443-1043
US

IV. Provider business mailing address

61 PINE ST STE 400
BRISTOL VT
05443-1043
US

V. Phone/Fax

Practice location:
  • Phone: 802-453-7422
  • Fax: 802-453-4815
Mailing address:
  • Phone: 802-453-7422
  • Fax: 802-453-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number032.0118028
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: