MEDICARE: DR. MARY M BEERWORTH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	42-0007267	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	216-5217	OTHER	VT	BC/BS GROUP PROVIDER #
2	16223	OTHER	VT	MVP ID #
3	10002440	OTHER	VT	CDPHP ID #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	216-5411	OTHER	VT	BC/BS INDIVIDUAL #

General Provider Information

NPI Number	:	1306843537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY M BEERWORTH M.D.

Provider Business Mailing Address
First Line	:	147 ALLEN ST
Second Line	:
City	:	RUTLAND
State	:	VT
Zip	:	05701-4570
Country	:	US
Telephone Number	:	802-775-1901
Fax Number	:	802-773-2867

Provider Business Practice Location Address
First Line	:	147 ALLEN STREET
Second Line	:
City	:	RUTLAND
State	:	VT
Zip	:	05701-4570
Country	:	US
Telephone Number	:	802-775-1901
Fax Number	:	802-773-2867

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	02/06/2012

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