Provider Demographics
NPI:1417250614
Name:KRECHETOFF, IRENE BARBARA (DO)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:BARBARA
Last Name:KRECHETOFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL CT
Mailing Address - Street 2:
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101-1489
Mailing Address - Country:US
Mailing Address - Phone:802-463-9000
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER ST
Practice Address - Street 2:SPRINGFIELD MEDICAL CARE SYSTEMS
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2930
Practice Address - Country:US
Practice Address - Phone:802-463-9000
Practice Address - Fax:802-463-3911
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY264119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program