Provider Demographics
NPI:1558604272
Name:THACH, SUSANNA BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:BRADLEY
Last Name:THACH
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 1:43 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 TIMBER LN
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5201
Practice Address - Country:US
Practice Address - Phone:802-495-0940
Practice Address - Fax:802-448-3765
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2025-09-05
Deactivation Date:2025-08-18
Deactivation Code:
Reactivation Date:2025-09-02
Provider Licenses
StateLicense IDTaxonomies
NC2016-02415207RH0002X
VT042.0013606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine