Provider Demographics
NPI:1508963596
Name:CAROL, SUSAN BETTY (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETTY
Last Name:CAROL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 FAIFIELD ST.
Mailing Address - Street 2:
Mailing Address - City:ST. ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478
Mailing Address - Country:US
Mailing Address - Phone:802-524-1223
Mailing Address - Fax:802-524-1095
Practice Address - Street 1:133 FAIFIELD ST.
Practice Address - Street 2:
Practice Address - City:ST. ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478
Practice Address - Country:US
Practice Address - Phone:802-524-1223
Practice Address - Fax:802-524-1095
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52047141205207P00000X
NY162694-12083X0100X
VT042.00139492083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine