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General NPI Number Information
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NPI Number | 1902144405
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Entity Type | Organization
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Legal Business Name | PETER C. STICKNEY, MD PC
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 69 ALLEN ST SUITE #5
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City | RUTLAND
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State | VT
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Zip | 05701-4590
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Country | US
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Telephone | 802-773-2626
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Fax | 802-773-5245
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Provider Business Mailing Address
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Address Line | 69 ALLEN ST SUITE #5
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City | RUTLAND
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State | VT
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Zip | 05701-4590
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Country | US
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Telephone | 802-773-2626
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Fax | 802-773-5245
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER C. STICKNEY
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Credential | MD
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Telephone | 802-773-2626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0420004909
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License Number State | VT
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