MEDICARE: MRS. TAMMY MICHELLE GERDES PA-C

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	363AM0700X	Medical Physician Assistant	0550030955	VT
2	363AM0700X	Medical Physician Assistant	0550030954	VT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010134	OTHER	VT	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639273246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMY MICHELLE GERDES PA-C

Provider Business Mailing Address
First Line	:	PO BOX 182
Second Line	:
City	:	BARNARD
State	:	VT
Zip	:	05031-0182
Country	:	US
Telephone Number	:	802-234-9913
Fax Number	:	802-234-5507

Provider Business Practice Location Address
First Line	:	1823 VT RTE 107
Second Line	:
City	:	BETHEL
State	:	VT
Zip	:	05032-9107
Country	:	US
Telephone Number	:	802-234-9913
Fax Number	:	802-234-5507

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	06/01/2010

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