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General NPI Number Information
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NPI Number | 1558604272
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Entity Type | Individual
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Provider Name | SUSANNA BRADLEY THACH M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 43 TIMBER LN
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-5201
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Country | US
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Telephone | 802-495-0940
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Fax | 802-448-3765
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Provider Business Mailing Address
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Address Line | 43 TIMBER LN
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-5201
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Country | US
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Telephone |
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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 | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 2016-02415
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 042.0013606
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License Number State | VT
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