Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0420008222 | VT |
N | 207Q00000X | Family Doctor | MD22764 | ME |
N | 207QA0401X | Family Doctor - Addiction Medicine | 042000 | VT |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD22764 | ME |
NPI | 1255380432 |
---|---|
Provider Name | Dr. Carol Thayer |
First Address | Burlington, VT 05401-5120 |
Second Address | Georgia, VT 05454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 17/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009919 | (05) | VT |
080176413 | RAIL ROAD MEDICARE (01) | VT |
B82831 | (02) |