Healthcare Provider Details

I. General information

NPI: 1386887818
Provider Name (Legal Business Name): JAIME PINEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE. UVM MEDICAL CENTER - SURGERY/TRANSPLANT
BURLINGTON VT
05401
US

IV. Provider business mailing address

111 COLCHESTER AVE. UVM MEDICAL CENTER - SURGERY/TRANSPLANT
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4774
  • Fax: 802-847-3619
Mailing address:
  • Phone: 802-847-4774
  • Fax: 802-847-3619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number042.0013175
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT193467
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: