Provider Demographics
NPI:1083627426
Name:VASSAR, CAROL ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNE
Last Name:VASSAR
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 1:150 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2913
Mailing Address - Country:US
Mailing Address - Phone:802-223-1766
Mailing Address - Fax:802-223-1767
Practice Address - Street 1:150 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2913
Practice Address - Country:US
Practice Address - Phone:802-223-1766
Practice Address - Fax:802-223-1767
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT7745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009549Medicaid
VT0009549Medicaid
B81847Medicare UPIN