Healthcare Provider Details

I. General information

NPI: 1639104417
Provider Name (Legal Business Name): MARJORIE CLARE MEYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE SMITH 419 MFU/FAHC OB/GYN
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

28 OLD CROSS RD
SOUTH BURLINGTON VT
05403-8100
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-5066
  • Fax: 802-847-2360
Mailing address:
  • Phone: 802-658-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0420007765
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0420007765
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: