Healthcare Provider Details

I. General information

NPI: 1063161107
Provider Name (Legal Business Name): ALEXANDER ZAJACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BELMONT AVE
BRATTLEBORO VT
05301-3498
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-0341
  • Fax: 802-251-8435
Mailing address:
  • Phone: 702-207-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042.0018637
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: