Provider Demographics
NPI:1679511711
Name:STITELMAN, MARTHA (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:STITELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:ZIEBUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 BLAIR PARK RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7586
Mailing Address - Country:US
Mailing Address - Phone:802-872-4342
Mailing Address - Fax:802-872-0282
Practice Address - Street 1:600BLAIR PARK RD
Practice Address - Street 2:SUITE 190
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-872-4342
Practice Address - Fax:802-872-0282
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-0008683207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
378491OtherMOHAWK VALLEY HEALTH PLAN
VT00018950OtherBLUE CROSS BLUE SHIELD
VT0VN0578Medicaid
VT0VN0578Medicaid
VT00018950OtherBLUE CROSS BLUE SHIELD