Healthcare Provider Details

I. General information

NPI: 1366571663
Provider Name (Legal Business Name): CAROL IBACH DUFFY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1988 EAST RD
SHAFTSBURY VT
05262-9778
US

IV. Provider business mailing address

1988 EAST RD
SHAFTSBURY VT
05262-9778
US

V. Phone/Fax

Practice location:
  • Phone: 484-624-2771
  • Fax:
Mailing address:
  • Phone: 484-624-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS010240L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: