Healthcare Provider Details

I. General information

NPI: 1336891118
Provider Name (Legal Business Name): ANTONY LEHTIKOSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 HOSPITALITY DR
BARRE VT
05641-5360
US

IV. Provider business mailing address

4 SPRING ST APT 2
MONTPELIER VT
05602-2288
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-0308
  • Fax:
Mailing address:
  • Phone: 470-774-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA063427
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number055.0031808
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00708300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: