Provider Demographics
NPI:1265622070
Name:NOELLE C THABAULT MD LLC
Entity type:Organization
Organization Name:NOELLE C THABAULT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:THABAULT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-862-7555
Mailing Address - Street 1:368 DORSET ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6236
Mailing Address - Country:US
Mailing Address - Phone:802-862-7555
Mailing Address - Fax:802-862-9555
Practice Address - Street 1:368 DORSET ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6236
Practice Address - Country:US
Practice Address - Phone:802-862-7555
Practice Address - Fax:802-862-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0008587207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014996Medicaid
VTVN3905Medicare PIN