Provider Demographics
NPI:1104925817
Name:ESSEX PEDIATRICS PC
Entity type:Organization
Organization Name:ESSEX PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS-LOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-879-6556
Mailing Address - Street 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3207
Mailing Address - Country:US
Mailing Address - Phone:802-879-6556
Mailing Address - Fax:802-872-8021
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-3207
Practice Address - Country:US
Practice Address - Phone:802-879-6556
Practice Address - Fax:802-872-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT120475208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1603Medicaid
VTOVN1603Medicaid