Provider Demographics
NPI:1063540623
Name:MAHAR CANNON, EMILY M (ND)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:M
Last Name:MAHAR CANNON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:M
Other - Last Name:MAHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:152 MAPLE ST STE 302
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1168
Mailing Address - Country:US
Mailing Address - Phone:802-458-0488
Mailing Address - Fax:802-458-0489
Practice Address - Street 1:152 MAPLE ST STE 302
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1168
Practice Address - Country:US
Practice Address - Phone:802-458-0488
Practice Address - Fax:802-458-0489
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0000230175F00000X
VT099-0000230175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015227Medicaid