Individual
EILEEN DOHERTY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1330 EXCHANGE ST STE 201, MIDDLEBURY, VT 05753-4464
(802) 388-1500
(802) 388-0441
Mailing address
1330 EXCHANGE ST STE 201, MIDDLEBURY, VT 05753-4464
(802) 388-1500
(802) 388-0441
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042-007267
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005628
—
VT
Enumeration date
01/05/2006
Last updated
10/14/2020
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