Healthcare Provider Details

I. General information

NPI: 1740361070
Provider Name (Legal Business Name): MARY BETH RAMUNDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE 272 SMITH, MCHV CAMPUS
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

12 QUAIL RUN
SOUTH BURLINGTON VT
05403-7807
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4594
  • Fax: 802-847-5322
Mailing address:
  • Phone: 802-660-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number042-0009124
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: