Provider Demographics
NPI:1861441578
Name:SAFERSTEIN, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SAFERSTEIN
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 1:133 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1726
Mailing Address - Country:US
Mailing Address - Phone:802-524-8952
Mailing Address - Fax:802-524-7021
Practice Address - Street 1:4178 HIGHBRIDGE RD
Practice Address - Street 2:
Practice Address - City:GEORGIA
Practice Address - State:VT
Practice Address - Zip Code:05454-5446
Practice Address - Country:US
Practice Address - Phone:802-524-9595
Practice Address - Fax:802-524-2867
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420006763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT080176412OtherRAIL ROAD MEDICARE
VT0005164Medicaid
VT0005164Medicaid
VTVT516401Medicare PIN
B85659Medicare UPIN
VTBX3984Medicare PIN