Healthcare Provider Details

I. General information

NPI: 1679511711
Provider Name (Legal Business Name): MARTHA STITELMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA ZIEBUR

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600BLAIR PARK RD SUITE 190
WILLISTON VT
05495
US

IV. Provider business mailing address

600 BLAIR PARK RD SUITE 190
WILLISTON VT
05495-7586
US

V. Phone/Fax

Practice location:
  • Phone: 802-872-4342
  • Fax: 802-872-0282
Mailing address:
  • Phone: 802-872-4342
  • Fax: 802-872-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number42-0008683
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: