Healthcare Provider Details

I. General information

NPI: 1306800081
Provider Name (Legal Business Name): MARIE L ZAGROBA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FISHER RD CENTRAL VT MEDICAL CENTER
BERLIN VT
05602-9516
US

IV. Provider business mailing address

PO BOX 297 6971 MAIN STREET
WAITSFIELD VT
05673-0297
US

V. Phone/Fax

Practice location:
  • Phone: 802-371-4257
  • Fax:
Mailing address:
  • Phone: 802-496-6161
  • Fax: 802-496-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042-0008339
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: