Healthcare Provider Details

I. General information

NPI: 1114257409
Provider Name (Legal Business Name): SUSAN WEHRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 COLLEGE PKWY
COLCHESTER VT
05446-3052
US

IV. Provider business mailing address

222 LOOMIS ST
BURLINGTON VT
05401-3337
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2345
  • Fax:
Mailing address:
  • Phone: 802-324-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0420008975
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: