Provider Demographics
NPI:1255314167
Name:MARIANI, KATHERINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:MARIANI
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 1:3 TIMBER LANE
Mailing Address - Street 2:UVM MEDICAL CENTER-ADULT PRIMARY CARE, S. BURLINGTON
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-8500
Mailing Address - Fax:802-847-6140
Practice Address - Street 1:3 TIMBER LANE
Practice Address - Street 2:UVM MEDICAL CENTER-ADULT PRIMARY CARE, S. BURLINGTON
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-8500
Practice Address - Fax:802-847-6140
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158362207Q00000X
VT042-0011674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3195201Medicaid
MA3195201Medicaid
MAMA A29143Medicare ID - Type Unspecified