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NPI Code Detail

MEDICARE: KRISTIN H PEKALA PA-C

MEDICARE:   KRISTIN H PEKALA  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant055-0030494VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992700884
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN H PEKALA PA-C
Provider Business Mailing Address
First Line : 331 OLCOTT DR
Second Line : STE U3
City : WHITE RIVER JUNCTION
State : VT
Zip : 05001-9601
Country : US
Telephone Number : 802-295-6132
Fax Number : 802-295-1358
Provider Business Practice Location Address
First Line : 331 OLCOTT DR
Second Line : STE U3
City : WHITE RIVER JUNCTION
State : VT
Zip : 05001-9601
Country : US
Telephone Number : 802-295-6132
Fax Number : 802-295-1358
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 05/20/2008

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Directions to “ KRISTIN H PEKALA PA-C” Practice Location

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