Individual
JUDITH TIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
185 GRAFTON RD., TOWNSHEND, VT 05353
(802) 365-7381
Mailing address
PO BOX 216, TOWNSHEND, VT 05353-0216
(802) 365-7381
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0420009132
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OVN0540
—
VT
Enumeration date
11/03/2005
Last updated
12/18/2007
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