Provider Demographics
NPI:1871688499
Name:NIEMIRA, DENISE AILEEN (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:AILEEN
Last Name:NIEMIRA
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 1:5452 U.S. RT. 5
Mailing Address - Street 2:STE. D
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855
Mailing Address - Country:US
Mailing Address - Phone:802-334-6140
Mailing Address - Fax:802-334-8271
Practice Address - Street 1:5452 U.S. RT. 5
Practice Address - Street 2:STE. D
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855
Practice Address - Country:US
Practice Address - Phone:802-334-6140
Practice Address - Fax:802-334-8271
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT.0007973Medicaid
VT8000428OtherLADIES FIRST PROVIDER NUM
VT8000428OtherLADIES FIRST PROVIDER NUM
VTWO-VT.5918Medicare ID - Type Unspecified