Provider Demographics
NPI:1912979337
Name:LADD, JENNIFER K (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:LADD
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 1:189 PROUTY DR
Mailing Address - Street 2:NORTH COUNTRY HOSPITAL DEPT. OF ANESTHESIOLOGY
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9326
Mailing Address - Country:US
Mailing Address - Phone:802-334-7331
Mailing Address - Fax:802-334-3281
Practice Address - Street 1:189 PROUTY DR
Practice Address - Street 2:NORTH COUNTRY HOSPITAL DEPT. OF ANESTHESIOLOGY
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9326
Practice Address - Country:US
Practice Address - Phone:802-334-7331
Practice Address - Fax:802-334-3281
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010782207L00000X
NY234736207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY234736-7WOtherWORKER'S COMPENSATION
NY02633558Medicaid
NY234736-7WOtherWORKER'S COMPENSATION
0168T1Medicare ID - Type Unspecified