Provider Demographics
NPI:1033286216
Name:KIRKPATRICK, BETH DIANE (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:DIANE
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 OSGOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05494-9738
Mailing Address - Country:US
Mailing Address - Phone:802-878-1036
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FLETCHER ALLEN HEALTH CARE
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009941207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02040288Medicaid
VT0VN2105Medicaid
H04401Medicare UPIN
KIVN2105Medicare ID - Type Unspecified