Provider Demographics
NPI:1376500058
Name:CODDAIRE, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:CODDAIRE
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 1:607 WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8652
Mailing Address - Country:US
Mailing Address - Phone:802-888-5639
Mailing Address - Fax:
Practice Address - Street 1:609 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8652
Practice Address - Country:US
Practice Address - Phone:802-888-5639
Practice Address - Fax:802-888-6040
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0005100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT080103401OtherRR MEDICARE
VT0004692Medicaid
VT8000718OtherLADIES FIRST
VT00004692OtherBLUE CROSS BLUE SHIELD
VT080103401OtherRR MEDICARE
VTB85710Medicare UPIN