Individual
MARK C STICKNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3 COMMONS ST, RUTLAND, VT 05701-4652
(802) 773-7155
(802) 773-7616
Mailing address
3 COMMONS ST, RUTLAND, VT 05701-4652
(802) 773-7155
(802) 773-7616
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042-0007705
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009219
—
VT
Enumeration date
08/05/2006
Last updated
11/24/2010
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