Provider Demographics
NPI:1275521908
Name:MCCRUM, MARGERY STICKNEY (MD)
Entity Type:Individual
Prefix:
First Name:MARGERY
Middle Name:STICKNEY
Last Name:MCCRUM
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 1:4923 US ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:VT
Mailing Address - Zip Code:05158-9651
Mailing Address - Country:US
Mailing Address - Phone:802-722-4023
Mailing Address - Fax:802-722-4137
Practice Address - Street 1:4923 US ROUTE 5
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:VT
Practice Address - Zip Code:05158-9651
Practice Address - Country:US
Practice Address - Phone:802-722-4023
Practice Address - Fax:802-722-4137
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0007609207L00000X
VT0420007609208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C65743Medicare UPIN