Healthcare Provider Details

I. General information

NPI: 1154483345
Provider Name (Legal Business Name): LIZABETH JANE PONTZER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 DORSET ST SUITE 10, STONE HOUSE ASSOCIATES
SOUTH BURLINGTON VT
05403-6209
US

IV. Provider business mailing address

324 NORTHVIEW CT
WILLISTON VT
05495-7353
US

V. Phone/Fax

Practice location:
  • Phone: 802-654-7607
  • Fax: 802-654-9155
Mailing address:
  • Phone: 802-578-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042-0011261
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: