Healthcare Provider Details

I. General information

NPI: 1407891674
Provider Name (Legal Business Name): HEATHER A. BIXLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALLEN ST MID-VERMONT PATHOLOGY
RUTLAND VT
05701-4560
US

IV. Provider business mailing address

160 ALLEN ST MID-VERMONT PATHOLOGY
RUTLAND VT
05701-4560
US

V. Phone/Fax

Practice location:
  • Phone: 802-747-1674
  • Fax:
Mailing address:
  • Phone: 802-747-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number042.0013134
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: