Provider Demographics
NPI:1467411769
Name:WEINSTEIN, SUSAN D (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 TIMBER LANE
Mailing Address - Street 2:UVM MEDICAL CENTER-ADULT PRIMARY CARE SOUTH BURLINGTON
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-4714
Mailing Address - Fax:802-847-6333
Practice Address - Street 1:1 TIMBER LANE
Practice Address - Street 2:UVM MEDICAL CENTER-ADULT PRIMARY CARE SOUTH BURLINGTON
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-4714
Practice Address - Fax:802-847-6333
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISW015533207R00000X
VT032.0107697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00285525OtherRAIL ROAD MEDICARE
MI0A110280OtherBCBS
MIA16056056Medicare PIN
MI0A110280OtherBCBS
MIH73619Medicare UPIN