MEDICARE: WOODSTOCK HEALTH CLINIC PLLC

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1518820851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODSTOCK HEALTH CLINIC PLLC

Provider Business Mailing Address
First Line	:	217 MAXHAM MEADOW WAY STE 3A
Second Line	:
City	:	WOODSTOCK
State	:	VT
Zip	:	05091-1162
Country	:	US
Telephone Number	:	802-324-1281
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 MAXHAM MEADOW WAY STE 3A
Second Line	:
City	:	WOODSTOCK
State	:	VT
Zip	:	05091-1162
Country	:	US
Telephone Number	:	802-324-1281
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PA-C
Name	:	MARJORIE GEWIRZ
Credential	:	PA-C
Telephone Number	:	802-324-1281

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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