Provider Demographics
NPI:1679528723
Name:GENEREAUX, STEPHEN H (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:GENEREAUX
Suffix:
Gender:M
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 8
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05051-0008
Mailing Address - Country:US
Mailing Address - Phone:802-222-3026
Mailing Address - Fax:855-868-7197
Practice Address - Street 1:65 MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05081
Practice Address - Country:US
Practice Address - Phone:802-757-2325
Practice Address - Fax:855-868-7197
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9110207Q00000X
VT420007871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009211Medicaid
VT080058695OtherRAIL ROAD MEDICARE
VT080058695OtherRAIL ROAD MEDICARE
B85476Medicare UPIN
VT0009211Medicaid
VTB85476Medicare PIN
VTVT9211Medicare PIN