Provider Demographics
NPI:1639104417
Name:MEYER, MARJORIE CLARE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:CLARE
Last Name:MEYER
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 1:28 OLD CROSS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-8100
Mailing Address - Country:US
Mailing Address - Phone:802-658-1866
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:SMITH 419 MFU/FAHC OB/GYN
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-5066
Practice Address - Fax:802-847-2360
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007765207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01092828Medicaid
VT0009261Medicaid
VTMEVT9261Medicare ID - Type Unspecified
NY01092828Medicaid