Provider Demographics
NPI:1336405760
Name:CROTHERS, JESSICA W (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:W
Last Name:CROTHERS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:111 COLCHESTER AVE.
Mailing Address - Street 2:UVM MEDICAL CTR., DEPT. OF PATHOLOGY & LABORATORY MED.
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-5121
Mailing Address - Fax:802-847-5905
Practice Address - Street 1:111 COLCHESTER AVE.
Practice Address - Street 2:UVM MEDICAL CTR., DEPT. OF PATHOLOGY & LABORATORY MED.
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-5121
Practice Address - Fax:802-847-5905
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
VT042.0013555207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program