Provider Demographics
NPI:1932182292
Name:O HARA, DEBORAH M (PA C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:O HARA
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-485-4161
Mailing Address - Fax:802-485-4163
Practice Address - Street 1:63 CRESCENT AVE
Practice Address - Street 2:GREEN MOUNTAIN FAMILY PRACTICE
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5704
Practice Address - Country:US
Practice Address - Phone:802-485-4161
Practice Address - Fax:802-485-4163
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030353207Q00000X
VT055.0030933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT90002631Medicaid
VT90002631Medicaid