Provider Demographics
NPI:1629112859
Name:DEPPE, SUSAN LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEIGH
Last Name:DEPPE
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:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-0671
Mailing Address - Country:US
Mailing Address - Phone:802-658-7441
Mailing Address - Fax:802-658-7441
Practice Address - Street 1:1565 COLCHESTER POINT RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6669
Practice Address - Country:US
Practice Address - Phone:802-658-7441
Practice Address - Fax:802-658-7441
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00073322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00006394Medicaid
VT00006394Medicaid