Healthcare Provider Details

I. General information

NPI: 1881960409
Provider Name (Legal Business Name): THOMAS ROBERT PACE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

8 STEARNS AVE
ESSEX JUNCTION VT
05452-2920
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2415
  • Fax: 802-847-5324
Mailing address:
  • Phone: 802-922-6192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042.0013807
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: