Individual
HANS PETER DIERCKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
275 ROUTE 30 N, BOMOSEEN, VT 05732-9647
(802) 468-5641
(802) 468-2923
Mailing address
71 ALLEN ST, STE 101, RUTLAND, VT 05701-4570
(802) 772-4414
(802) 772-7973
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0420006786
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005458
—
VT
05
—
02622237
—
NY
Enumeration date
07/16/2006
Last updated
11/29/2016
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