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General NPI Number Information
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NPI Number | 1326149220
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Entity Type | Individual
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Provider Name | SUSAN WHITMAN PA
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 425 PEARL ST
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City | BURLINGTON
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State | VT
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Zip | 05401-3308
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Country | US
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Telephone | 802-656-3350
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Fax | 802-656-8001
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Provider Business Mailing Address
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Address Line | 1450 JOHNNIE BROOK RD
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City | RICHMOND
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State | VT
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Zip | 05477-4412
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Country | US
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Telephone | 802-578-5146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0550030747
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License Number State | VT
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