Individual
MS. MARJORIE NIKKI GEWIRZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
44 S MAIN ST, SURGICAL ASSOCIATES, RANDOLPH, VT 05060-1381
(802) 728-2372
(802) 728-2613
Mailing address
44 S MAIN ST, SURGICAL ASSOCIATES, RANDOLPH, VT 05060-1381
(802) 728-2372
(802) 728-2613
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055-0030993
VT
363AS0400X
Surgical Physician Assistant
055-0030993
VT
363AS0400X
Surgical Physician Assistant
055-0031029
VT
363AS0400X
Surgical Physician Assistant
0581
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0013358
MEDICARE PTAN
VT
05
—
9000284
—
VT
Enumeration date
06/14/2006
Last updated
10/30/2023
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