Provider Demographics
NPI:1114962495
Name:SCHOLTEN, MARIETTA C (MD)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:C
Last Name:SCHOLTEN
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:PO BOX 166
Mailing Address - Street 2:148 FAIRFIELD STREET
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-0166
Mailing Address - Country:US
Mailing Address - Phone:802-524-2168
Mailing Address - Fax:802-524-0411
Practice Address - Street 1:148 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1729
Practice Address - Country:US
Practice Address - Phone:802-524-2168
Practice Address - Fax:802-524-0411
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009209Medicaid
VTB85475Medicare UPIN
VT0009209Medicaid