Provider Demographics
NPI:1477583250
Name:BETTENCOURT, MARIE-CLAUDE (MD)
Entity type:Individual
Prefix:
First Name:MARIE-CLAUDE
Middle Name:
Last Name:BETTENCOURT
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:PO BOX 1612
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-1612
Mailing Address - Country:US
Mailing Address - Phone:802-886-3556
Mailing Address - Fax:802-886-2535
Practice Address - Street 1:29 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3060
Practice Address - Country:US
Practice Address - Phone:802-886-3556
Practice Address - Fax:802-886-2535
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010862208800000X
VA0101252507208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477583250Medicaid
VT1011134Medicaid
NH3070634Medicaid
VT1011134Medicaid
VA1477583250Medicaid