Healthcare Provider Details

I. General information

NPI: 1073596847
Provider Name (Legal Business Name): ROBERT E GRAMLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE UVM MEDICAL CENTER - PALLIATIVE CARE SERVICES
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE UVM MEDICAL CENTER - PALLIATIVE CARE SERVICES
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4848
  • Fax: 802-847-2929
Mailing address:
  • Phone: 802-847-4848
  • Fax: 802-847-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD10890
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number248222
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number042.0013387
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number248222
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: