Healthcare Provider Details

I. General information

NPI: 1154353274
Provider Name (Legal Business Name): REBECCA ANN FOULK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

79 SOUTH WINDSOR ST
SOUTH ROYALTON VT
05068
US

IV. Provider business mailing address

PO BOX 119 SOUTH ROYALTON HEALTH CENTER
SOUTH ROYALTON VT
05068
US

V. Phone/Fax

Practice location:
  • Phone: 802-763-7575
  • Fax: 802-763-2190
Mailing address:
  • Phone: 802-763-7575
  • Fax: 802-763-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0006862
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: