Provider Demographics
NPI:1275657280
Name:KAUFMAN, ANNICK-MARIE VOTTELER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNICK-MARIE
Middle Name:VOTTELER
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNICK-MARIE
Other - Middle Name:
Other - Last Name:VOTTELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-0905
Mailing Address - Country:US
Mailing Address - Phone:802-748-8141
Mailing Address - Fax:
Practice Address - Street 1:1315 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9210
Practice Address - Country:US
Practice Address - Phone:802-748-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6666666208600000X
VT0420012950208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1023635Medicaid
NH3098441Medicaid
VT1023635Medicaid
OR141276Medicare PIN