Provider Demographics
NPI:1972682128
Name:ANTLEY, CATHERINE MURER (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MURER
Last Name:ANTLEY
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 1:885 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-6168
Mailing Address - Country:US
Mailing Address - Phone:802-861-6240
Mailing Address - Fax:
Practice Address - Street 1:30 FARRELL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6112
Practice Address - Country:US
Practice Address - Phone:802-658-6269
Practice Address - Fax:802-860-4642
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0429794207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1891Medicaid
G84389Medicare UPIN
VN1891Medicare ID - Type Unspecified