Basic Information
| Provider Information | |||||||||
| NPI: | 1871582320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WULFMAN | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | WULFMAN | ||||||||
| OtherFirstName: | CARRIE | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 104 PORTER DR | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057538527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023888808 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 61 COURT DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057338407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022473756 | ||||||||
| FaxNumber: | 8022474560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0420009750 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0VN1853 | 05 | VT | MEDICAID |