Provider Demographics
NPI:1619955069
Name:COOMBS, SETH G (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:G
Last Name:COOMBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 COMMONS ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4651
Mailing Address - Country:US
Mailing Address - Phone:802-770-1805
Mailing Address - Fax:802-773-4876
Practice Address - Street 1:8 COMMONS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4651
Practice Address - Country:US
Practice Address - Phone:802-770-1805
Practice Address - Fax:802-773-4876
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1341Medicaid
VTOVN1341Medicaid
VTVN1341Medicare ID - Type Unspecified