Provider Demographics
NPI:1457326142
Name:GAIDA MICHAELS, GRETCHEN M (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
Last Name:GAIDA MICHAELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:M
Other - Last Name:GAIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:104 PORTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8527
Mailing Address - Country:US
Mailing Address - Phone:802-388-8808
Mailing Address - Fax:802-388-8322
Practice Address - Street 1:104 PORTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8527
Practice Address - Country:US
Practice Address - Phone:802-388-5682
Practice Address - Fax:802-388-8322
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0012102207R00000X
MA222532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ27995OtherBLUE CROSS
MA2078881Medicaid
MA469726OtherTUFTS
MAAA17100OtherHARVARD PILGRIM
MAI18824Medicare UPIN
MA2078881Medicaid