Provider Demographics
NPI:1255380432
Name:THAYER, CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:THAYER
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 1:32 PITKIN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5120
Mailing Address - Country:US
Mailing Address - Phone:802-238-4972
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
Practice Address - Country:US
Practice Address - Phone:802-524-9595
Practice Address - Fax:802-524-2867
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22764207Q00000X, 207QA0401X
VT042000207QA0401X
VT0420008222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009919Medicaid
VT080176413OtherRAIL ROAD MEDICARE
VTVT9919Medicare PIN
B82831Medicare UPIN
VTSX0474Medicare PIN