Provider Demographics
NPI:1578822748
Name:LEFER, THEODORE BENEDICT (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:BENEDICT
Last Name:LEFER
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 1:185 GRAFTON RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSHEND
Mailing Address - State:VT
Mailing Address - Zip Code:05353-8820
Mailing Address - Country:US
Mailing Address - Phone:541-789-4281
Mailing Address - Fax:541-789-2558
Practice Address - Street 1:17 BELMONT AVE
Practice Address - Street 2:ATTENTION REINA CHAMPNEY
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-0530
Practice Address - Country:US
Practice Address - Phone:802-257-0341
Practice Address - Fax:802-257-8834
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD172079207Q00000X
VT042.0014207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6703475Medicaid
NH3122212Medicaid