Provider Demographics
NPI:1841231735
Name:BOERNER, CAROL F (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:F
Last Name:BOERNER
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 1:441 RIVER STREET, PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156
Mailing Address - Country:US
Mailing Address - Phone:802-886-3937
Mailing Address - Fax:802-886-3167
Practice Address - Street 1:130 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-3628
Practice Address - Country:US
Practice Address - Phone:603-542-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11262207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNX0745OtherPALMETTO GBA
VTVN1908Medicare PIN
NHRE6152Medicare PIN
NHNX0745OtherPALMETTO GBA