Provider Demographics
NPI:1306013180
Name:BEAR, MARTHA (DO)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:BEAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:MAY
Other - Last Name:CORDIOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-2345
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363A00000X
VT031.0133499207Q00000X
MECC3325101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine