Healthcare Provider Details

I. General information

NPI: 1689660912
Provider Name (Legal Business Name): DAVID OSPINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FISHER RD MOB-B, STE 3
BERLIN VT
05602-9516
US

IV. Provider business mailing address

PO BOX 547 CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-225-5400
  • Fax: 802-225-5401
Mailing address:
  • Phone: 802-225-5400
  • Fax: 802-225-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number9677
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0420009677
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: