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NPI Code Detail

MEDICARE: AMY THIBAULT M.D.

MEDICARE: AMY THIBAULT 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
1207V00000XObstetrics & Gynecology Physician0420010606VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700832086
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY THIBAULT M.D.
Provider Business Mailing Address
First Line : 185 TILLEY DR
Second Line :
City : SOUTH BURLINGTON
State : VT
Zip : 05403-4484
Country : US
Telephone Number : 802-862-7338
Fax Number : 802-862-8411
Provider Business Practice Location Address
First Line : 185 TILLEY DR
Second Line :
City : SOUTH BURLINGTON
State : VT
Zip : 05403-4484
Country : US
Telephone Number : 802-862-7338
Fax Number : 802-862-8411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 10/17/2010

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