Healthcare Provider Details

I. General information

NPI: 1215669205
Provider Name (Legal Business Name): ALEXANDER JACOB ROVNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date: 05/30/2023
Reactivation Date: 07/13/2023

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-0000
  • Fax:
Mailing address:
  • Phone: 802-847-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number060.0005973
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: