KEITH FORTIER (NPI# 1740390053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740390053 |
| Entity Type | Individual |
| Full Name | KEITH FORTIER |
| Credential | M.D. |
| Practice Address |
594 Copenhagen Rd Waterford VT 05819-9055 |
| Practice Telephone | 8027488573 |
| Practice Fax Number | 7077348573 |
| Mailing Telephone | 8027488573 |
| Mailing Fax Number | 7077348573 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-01-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 042-0006155 | VT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VT | 0007981 | 05 |
| Street Address |
594 COPENHAGEN RD |
| City | WATERFORD |
| State | VT |
| Zip Code | 05819-9055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710457353 | Amber L Carrasquillo | Pharmacist | 438 Railroad St Apt 301, Saint Johnsbury, VT 05819 | 2018-11-27 |
| 1700378734 | Laura Amy Nixon | Physician Assistant | 41 Sherman Drive, St. Johnsbury, VT 05819 | 2018-06-05 |
| 1447797873 | Kingdom Autism and Behavioral Health, LLC | Behavioral Analyst | 397 Railroad Street, Suite Number #4, St. Johnsbury, VT 05819 | 2017-01-24 |
| 1407211493 | Scott Rosemark | Pharmacist | 957 Memorial Drive, Saint Johnsbury, VT 05819 | 2015-12-18 |
| 1134541295 | Meghan Davis | Counselor | 231 Concord Ave Ste 2, St Johnsbury, VT 05819 | 2014-01-09 |
| 1639490279 | Carol Lynn Smith | Counselor | 445 Portland St, St. Johnsbury, VT 05819 | 2010-06-17 |
| 1548435696 | Philip Lightbear | Counselor | 108 Cherry Street Suite 1, St Johnsburg, VT 05819 | 2008-04-29 |
| 1740452416 | Kimberly Dena Lightbear | Counselor | 108 Cherry Street, St Johnsbury, VT 05819 | 2008-04-02 |
| 1720262249 | Deborah B Goldberg | Psychologist | 1194 Main Street, Suite 107, St Johnsbury, VT 05819 | 2007-12-19 |
| 1154501880 | Mary Jane Egerton | Social Worker | 506 Tripp Lane, St Johnsburg, VT 05819 | 2007-11-09 |
| Find all providers in zip 05819 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346548302 | Harvey Lee Raimi | Obstetrics & Gynecology | 950 N Cass Lake Rd Ste 112, Waterford, MI 48328-2370 | 2011-03-01 |
| 1093804619 | Richard Ira Ellenbogen | Obstetrics & Gynecology | 4000 Highland Road, #120, Waterford, MI 48328 | 2006-10-12 |
| 1396787586 | Reda A Khalifa | Obstetrics & Gynecology | 3675 Highland Rd, Suite 112, Waterford, MI 48328-2326 | 2006-06-12 |
| 1942241633 | Michael Nicholson | Obstetrics & Gynecology | 5220 Highland Rd Ste 230, Waterford, MI 48327-1973 | 2006-06-10 |
| 1396707048 | Leonard Gordon Dorey | Obstetrics & Gynecology | 25 Pleasant Lake Dr, Waterford, MI 48327-3765 | 2006-04-06 |
| 1316919681 | Briana M Williams | Obstetrics & Gynecology | 818 Forrest Lane, Waterford, WI 53185-4577 | 2006-02-02 |
| 1417262387 | Cara Elizabeth Smith | Obstetrics & Gynecology | 5220 Highland Rd Ste 230, Waterford, MI 48327-1973 | 2010-08-16 |
| 1295881373 | Michael R Nicholson Md Pllc | Obstetrics & Gynecology | 5220 Highland Rd, Suite 230, Waterford, MI 48327-1975 | 2007-01-25 |
| 1912014416 | Stacy Ann Jenkins | Obstetrics & Gynecology | 5220 Highland Rd, Suite 230, Waterford, MI 48327-1913 | 2006-08-23 |
| 1578678140 | Dr Khalifa Reda Pllc | Obstetrics & Gynecology | 950 N Cass Lake Rd, Suite 112, Waterford, MI 48328-2370 | 2006-08-21 |
| Find all providers in WATERFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.