Healthcare Provider Details

I. General information

NPI: 1407889769
Provider Name (Legal Business Name): MARIO ESTRIN TRABULSY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE FAHC EMERGENCY DEPARTMENT
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

1086 BRAELOCH RD
COLCHESTER VT
05446-7478
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3982
  • Fax:
Mailing address:
  • Phone: 802-893-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number42-0009271
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: