Basic Information
| Provider Information | |||||||||
| NPI: | 1376500058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CODDAIRE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 WASHINGTON HWY | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056618652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028885639 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 609 WASHINGTON HWY | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056618652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028885688 | ||||||||
| FaxNumber: | 8028886040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 042-0005100 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8000718 | 01 | VT | LADIES FIRST | OTHER | 0004692 | 05 | VT | MEDICAID | 00004692 | 01 | VT | BLUE CROSS BLUE SHIELD | OTHER | 080103401 | 01 | VT | RR MEDICARE | OTHER |