Provider Demographics
NPI:1477724201
Name:IBANEZ, MARIA TERESA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:TERESA
Last Name:IBANEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1311 BARRE MONTPELIER ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05641
Mailing Address - Country:US
Mailing Address - Phone:802-371-4100
Mailing Address - Fax:802-225-3984
Practice Address - Street 1:1311 BARRE MONTPELIER ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05641
Practice Address - Country:US
Practice Address - Phone:802-371-4100
Practice Address - Fax:802-225-3984
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3750213ES0103X
VT056.0000199213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery