Provider Demographics
NPI:1285892299
Name:WITHERS, NATASHA ALEXA (DO)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:ALEXA
Last Name:WITHERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PINE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1043
Mailing Address - Country:US
Mailing Address - Phone:802-453-7422
Mailing Address - Fax:802-453-4815
Practice Address - Street 1:61 PINE ST STE 400
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1043
Practice Address - Country:US
Practice Address - Phone:802-453-7422
Practice Address - Fax:802-453-4815
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032.0118028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine