Provider Demographics
NPI:1144314196
Name:DENISE A. NIEMIRA, M.D., P.C.
Entity type:Organization
Organization Name:DENISE A. NIEMIRA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:AILEEN
Authorized Official - Last Name:NIEMIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-334-6140
Mailing Address - Street 1:5452 US ROUTE 5
Mailing Address - Street 2:STE. D
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9870
Mailing Address - Country:US
Mailing Address - Phone:802-334-6140
Mailing Address - Fax:802-334-8271
Practice Address - Street 1:5452 US ROUTE 5
Practice Address - Street 2:STE. D
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9870
Practice Address - Country:US
Practice Address - Phone:802-334-6140
Practice Address - Fax:802-334-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT8000428OtherLADIES FIRST
VTVT.0007973Medicaid
VT8000428OtherLADIES FIRST
VTVT.0007973Medicaid