Provider Demographics
NPI:1245343540
Name:TISCHLER, MARC DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DAVID
Last Name:TISCHLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 ROUTE 116
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7201
Mailing Address - Country:US
Mailing Address - Phone:802-860-3686
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-3734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0008327207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01258171Medicaid
VT0VN0145Medicaid
VT0VN0145Medicaid
TIVN0145Medicare ID - Type Unspecified