Healthcare Provider Details

I. General information

NPI: 1780684902
Provider Name (Legal Business Name): ESTELA VALERIAN OGISTE MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HOSPITAL AVE STE 110
NORTH ADAMS MA
01247-2592
US

IV. Provider business mailing address

322 DEWEY ST
BENNINGTON VT
05201-2225
US

V. Phone/Fax

Practice location:
  • Phone: 413-664-6736
  • Fax: 413-664-7349
Mailing address:
  • Phone: 802-447-8700
  • Fax: 802-447-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number042.0014908
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number213367
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number151
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: