Provider Demographics
NPI:1851429690
Name:SUITER, ELIZABETH GUTHRIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GUTHRIE
Last Name:SUITER
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 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-479-3302
Mailing Address - Fax:802-225-5720
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4881
Practice Address - Country:US
Practice Address - Phone:802-479-3302
Practice Address - Fax:802-225-5720
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036611207R00000X
WAMD60097715207R00000X
VT042.0012816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1022575Medicaid
VT1022575Medicaid