Healthcare Provider Details

I. General information

NPI: 1659438323
Provider Name (Legal Business Name): SUZANNE REVOIR PARKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PINE ST
BURLINGTON VT
05401-8421
US

IV. Provider business mailing address

311 WHALLEY RD
CHARLOTTE VT
05445-9532
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-6595
  • Fax: 802-862-4062
Mailing address:
  • Phone: 802-425-3339
  • Fax: 802-425-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number0420005358
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: