Healthcare Provider Details

I. General information

NPI: 1871522748
Provider Name (Legal Business Name): MICHELL THURMOND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 ALLEN ST SUITE 1
RUTLAND VT
05701-4564
US

IV. Provider business mailing address

69 ALLEN ST SUITE 1
RUTLAND VT
05701-4564
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-3314
  • Fax: 802-775-9617
Mailing address:
  • Phone: 802-775-3314
  • Fax: 802-775-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number042-0011179
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: