Provider Demographics
NPI:1205836863
Name:SEYFERTH, ERIC STEVEN (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:STEVEN
Last Name:SEYFERTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HOSPITAL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5018
Mailing Address - Country:US
Mailing Address - Phone:802-442-7855
Mailing Address - Fax:802-442-6638
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5018
Practice Address - Country:US
Practice Address - Phone:802-442-7855
Practice Address - Fax:802-442-6638
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0007982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009437Medicaid
030320620OtherCIGNA
11012OtherMVP
VT1601OtherBCBS VERMONT
010028337OtherRAILROAD MEDICARE
T001346OtherTRICARE
VT11012OtherMVP
NY76573OtherGHI
VT11012OtherMVP
NY76573OtherGHI