Healthcare Provider Details

I. General information

NPI: 1528599297
Provider Name (Legal Business Name): IRENE CHAMBERLAIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 BARRE-MONTPELIER ROAD, SUITE 200 CVMC EXPRESSCARE
BERLIN VT
05602
US

IV. Provider business mailing address

PO BOX 547 ATTN: FINANCE DEPARTMENT
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-371-4239
  • Fax: 802-371-4237
Mailing address:
  • Phone: 802-371-4239
  • Fax: 802-371-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: