Healthcare Provider Details

I. General information

NPI: 1528596194
Provider Name (Legal Business Name): MAX HALLETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FISHER RD UNIT 1
BERLIN VT
05602-8132
US

IV. Provider business mailing address

130 FISHER RD UNIT 1
BERLIN VT
05602-8132
US

V. Phone/Fax

Practice location:
  • Phone: 802-225-1743
  • Fax:
Mailing address:
  • Phone: 802-225-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number032.0134220
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT018040
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: