Provider Demographics
NPI:1922062959
Name:READY, MARY O (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:O
Last Name:READY
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 1:165 SHERMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819
Mailing Address - Country:US
Mailing Address - Phone:802-748-9405
Mailing Address - Fax:802-748-4540
Practice Address - Street 1:201 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:VT
Practice Address - Zip Code:05824-0355
Practice Address - Country:US
Practice Address - Phone:802-695-2512
Practice Address - Fax:802-695-1303
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011939Medicaid
VTI42931Medicare UPIN
VTVN3825Medicare ID - Type UnspecifiedMEDICARE NUMBER
VT471801Medicare Oscar/Certification