Basic Information
| Provider Information | |||||||||
| NPI: | 1477724201 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IBANEZ | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | TERESA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 BARRE MONTPELIER ROAD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BERLIN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023714100 | ||||||||
| FaxNumber: | 8022253984 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 BARRE MONTPELIER ROAD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BERLIN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023714100 | ||||||||
| FaxNumber: | 8022253984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2008 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | PO3750 | FL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | 056.0000199 | VT | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.