Provider Demographics
NPI:1568606416
Name:MERTZ, MICHELLE JENNIFER (MD)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:JENNIFER
Last Name:MERTZ
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 1:22 COMMERCE ST
Mailing Address - Street 2:FAHC/HINESBURG FAMILY HEALTH
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-9303
Mailing Address - Country:US
Mailing Address - Phone:802-847-7000
Mailing Address - Fax:802-847-5238
Practice Address - Street 1:22 COMMERCE ST
Practice Address - Street 2:FAHC - HINESBURG FAMILY MEDICINE
Practice Address - City:HINESBURG
Practice Address - State:VT
Practice Address - Zip Code:05461-9303
Practice Address - Country:US
Practice Address - Phone:802-847-7000
Practice Address - Fax:802-847-5238
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109764207Q00000X
VT0420012791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN