Healthcare Provider Details

I. General information

NPI: 1851317242
Provider Name (Legal Business Name): MARY LEE B. RITTER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

94 ROBIN RD
COLCHESTER VT
05446-6727
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4696
  • Fax: 802-847-4612
Mailing address:
  • Phone: 802-863-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1010015469
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: