Provider Demographics
NPI:1336438712
Name:GUTH, SARAH ELLEN EBERHARDT (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELLEN EBERHARDT
Last Name:GUTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-4316
Mailing Address - Fax:802-371-4579
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:CVMC PSYCHAITRY DEPT
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-371-4316
Practice Address - Fax:802-371-4579
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VT042.00128872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1023567Medicaid
VTY400161253Medicare PIN