Healthcare Provider Details

I. General information

NPI: 1033286216
Provider Name (Legal Business Name): BETH DIANE KIRKPATRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE FLETCHER ALLEN HEALTH CARE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

750 OSGOOD HILL RD
WESTFORD VT
05494-9738
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4594
  • Fax:
Mailing address:
  • Phone: 802-878-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number042-0009941
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: