Provider Demographics
NPI:1336107192
Name:THABAULT, NOELLE C (MD)
Entity Type:Individual
Prefix:DR
First Name:NOELLE
Middle Name:C
Last Name:THABAULT
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 1:368 DORSET ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6212
Mailing Address - Country:US
Mailing Address - Phone:802-862-7555
Mailing Address - Fax:
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:05403-6212
Practice Address - Country:US
Practice Address - Phone:802-862-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008587207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0429Medicaid
VTNX4162Medicare PIN
VTVN0429Medicare PIN
VTOVN0429Medicaid