Organization
OBSTETRICS,GYNECOLOGY,INFERTILITY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY M BEERWORTH M.D. (PRESIDENT)
(802) 773-7777
Entity
Organization
Contact information
Practice address
71 ALLEN ST, SUITE 402, RUTLAND, VT 05701-4570
(802) 773-7777
(802) 773-2867
Mailing address
71 ALLEN ST, SUITE 402, RUTLAND, VT 05701-4570
(802) 773-7777
(802) 773-2867
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1945
GROUP CDPHP BILLING ID
VT
01
—
216-5217
VT BC/BS GROUP ID NUMBER
VT
05
—
VT9114
—
VT
Enumeration date
10/06/2005
Last updated
03/27/2008
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