Provider Demographics
NPI:1285682666
Name:PITCHER, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PITCHER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:368 DORSET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6212
Mailing Address - Country:US
Mailing Address - Phone:802-860-1441
Mailing Address - Fax:802-860-4646
Practice Address - Street 1:368 DORSET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6212
Practice Address - Country:US
Practice Address - Phone:802-860-1441
Practice Address - Fax:802-860-4646
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT42-0007896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT110213928OtherRAIL ROAD MEDICARE
VT0009567Medicaid
VT0009567Medicaid
E27017Medicare UPIN
VTMX4387Medicare PIN