Provider Demographics
NPI:1447248299
Name:OBSTETRICS,GYNECOLOGY,INFERTILITY P.C.
Entity type:Organization
Organization Name:OBSTETRICS,GYNECOLOGY,INFERTILITY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEERWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-773-7777
Mailing Address - Street 1:71 ALLEN ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-773-7777
Mailing Address - Fax:802-773-2867
Practice Address - Street 1:71 ALLEN ST
Practice Address - Street 2:SUITE 402
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4570
Practice Address - Country:US
Practice Address - Phone:802-773-7777
Practice Address - Fax:802-773-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT216-5217OtherVT BC/BS GROUP ID NUMBER
VT1945OtherGROUP CDPHP BILLING ID
VTVT9114Medicaid
VTVT9114Medicaid