Healthcare Provider Details

I. General information

NPI: 1447248299
Provider Name (Legal Business Name): OBSTETRICS,GYNECOLOGY,INFERTILITY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 ALLEN ST SUITE 402
RUTLAND VT
05701-4570
US

IV. Provider business mailing address

71 ALLEN ST SUITE 402
RUTLAND VT
05701-4570
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-7777
  • Fax: 802-773-2867
Mailing address:
  • Phone: 802-773-7777
  • Fax: 802-773-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY M BEERWORTH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 802-773-7777