Basic Information
| Provider Information | |||||||||
| NPI: | 1235188418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STURGIS | ||||||||
| FirstName: | MIRIAM | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 FAIRFIELD ST | ||||||||
| Address2: | |||||||||
| City: | SAINT ALBANS | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054781726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025248952 | ||||||||
| FaxNumber: | 8025247021 | ||||||||
| Practice Location | |||||||||
| Address1: | 4178 HIGHBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | GEORGIA | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054545446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025249595 | ||||||||
| FaxNumber: | 8025242867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 11/15/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0420007475 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0006485 | 05 | VT | MEDICAID |