Healthcare Provider Details

I. General information

NPI: 1255380432
Provider Name (Legal Business Name): CAROL THAYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 03/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4178 HIGHBRIDGE RD
GEORGIA VT
05454
US

IV. Provider business mailing address

32 PITKIN ST
BURLINGTON VT
05401-5120
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-9595
  • Fax: 802-524-2867
Mailing address:
  • Phone: 802-238-4972
  • Fax: 802-524-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD22764
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number042000
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD22764
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420008222
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: