Healthcare Provider Details

I. General information

NPI: 1184112062
Provider Name (Legal Business Name): ETHAN ANDREW BUHL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BELMONT AVE OFC BUILDING
BRATTLEBORO VT
05301-7109
US

IV. Provider business mailing address

146 GREEN ST UNIT 1
BRATTLEBORO VT
05301-6054
US

V. Phone/Fax

Practice location:
  • Phone: 802-251-8650
  • Fax:
Mailing address:
  • Phone: 607-237-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number056.0000198
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: