Individual
TRACEY SUE MAURER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
353 BLAIR PARK RD, WILLISTON, VT 05495-7530
(802) 847-1600
Mailing address
41 ALPINE DR, JERICHO, VT 05465-2071
(802) 899-3697
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
042-0010177
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02128861
NY MEDICAID
NY
05
—
0VN2505
—
VT
Enumeration date
07/27/2006
Last updated
07/08/2007
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