Provider Demographics
NPI:1487642807
Name:HALE, JERRY STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:STEVEN
Last Name:HALE
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 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3207
Mailing Address - Country:US
Mailing Address - Phone:802-879-6556
Mailing Address - Fax:802-872-8021
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-3207
Practice Address - Country:US
Practice Address - Phone:802-879-6556
Practice Address - Fax:802-872-8021
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-0008917208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0885Medicaid
VTHA VN2782Medicare ID - Type Unspecified
VTF99980Medicare UPIN