Healthcare Provider Details

I. General information

NPI: 1538553656
Provider Name (Legal Business Name): SARAH RUTH GILLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE MAILSTOP 156SM2
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE MAILSTOP 156SM2
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2700
  • Fax:
Mailing address:
  • Phone: 802-847-4953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number042-0015596
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number042-0015596
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number042-0015596
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: