Healthcare Provider Details

I. General information

NPI: 1831240092
Provider Name (Legal Business Name): STEPHEN F. PAULUS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PINE HAVEN SHORES ROAD SUITE 2061
BURLINGTON VT
05401-1523
US

IV. Provider business mailing address

145 PINE HAVEN SHORES ROAD SUITE 2061
BURLINGTON VT
05401-1523
US

V. Phone/Fax

Practice location:
  • Phone: 802-489-5470
  • Fax: 802-497-0867
Mailing address:
  • Phone: 802-489-5470
  • Fax: 802-497-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number032.0058141
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number032.0058141
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: