Provider Demographics
NPI:1306978804
Name:PELLETIER, CORINNE ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:ANNE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 CHURCH ST
Mailing Address - Street 2:SUITE 4-E
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4299
Mailing Address - Country:US
Mailing Address - Phone:802-863-7014
Mailing Address - Fax:802-652-5146
Practice Address - Street 1:2 CHURCH ST
Practice Address - Street 2:SUITE 4-E
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4299
Practice Address - Country:US
Practice Address - Phone:802-863-7014
Practice Address - Fax:802-652-5146
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT04200093322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTG36945Medicare UPIN