Individual
DR. THOMAS SUPPAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-2377
(802) 847-9644
Mailing address
419 S PROSPECT ST, BURLINGTON, VT 05401-3506
(802) 658-0052
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
042-0009724
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01866444
—
NY
05
—
0VN1782
—
VT
Enumeration date
07/12/2006
Last updated
07/08/2007
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