| Jennifer Fauntleroy, M.d., P.c. | |
|
11 Court Sq Rutland VT 05701-4030 | |
| (802) 775-1398 | |
| (802) 775-5196 |
| Full Name | Jennifer Fauntleroy, M.d., P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11 Court Sq, Rutland, Vermont |
| Authorized Official Name and Position | Jennifer Mary Fauntleroy (OWNER) |
| Authorized Official Contact | 8027751398 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Fauntleroy, M.d., P.c. 11 Court Sq Rutland VT 05701-4030 Ph: (802) 775-1398 | Jennifer Fauntleroy, M.d., P.c. 11 Court Sq Rutland VT 05701-4030 Ph: (802) 775-1398 |
| NPI Number | 1669498853 |
|---|---|
| Provider Enumeration Date | 07/14/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0042231078 |
|---|---|
| Medicare Enrollment ID | O20051219000025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669498853 | NPI | - | NPPES |
| 0VN1669 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 042-0009568 (Vermont) | Primary |
| Provider Name | Jennifer M Fauntleroy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669448981 PECOS PAC ID: 9234028705 Enrollment ID: I20051219000037 |
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