=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982702650
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH ANN MAIER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 266 FISHER RD STE 1
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-9179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-371-5950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 RANDALL ST STE 1
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05676-1571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-244-7472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 042-0006268
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------