Healthcare Provider Details

I. General information

NPI: 1477500593
Provider Name (Legal Business Name): JILL STUART RINEHART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LAKESIDE AVE SUITE 115
BURLINGTON VT
05401-4939
US

IV. Provider business mailing address

128 LAKESIDE AVE SUITE 115
BURLINGTON VT
05401-4939
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-1928
  • Fax: 802-860-0192
Mailing address:
  • Phone: 802-860-1928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420009849
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: