Individual
JOSEPH G THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 W MAIN ST, RICHMOND, VT 05477-4479
(802) 434-4123
(802) 434-3130
Mailing address
30 W MAIN ST, RICHMOND, VT 05477-4479
(802) 434-4123
(802) 434-3130
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0420010278
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008108
—
VT
Enumeration date
08/09/2006
Last updated
08/02/2012
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