Healthcare Provider Details

I. General information

NPI: 1457615650
Provider Name (Legal Business Name): MELANIE RAE BUI M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE UVM MEDICAL CENTER - DERMATOLOGY
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE UVM MEDICAL CENTER - DERMATOLOGY
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4570
  • Fax: 802-847-3364
Mailing address:
  • Phone: 802-847-4570
  • Fax: 802-847-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number042.0013526
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301101321
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: