Healthcare Provider Details

I. General information

NPI: 1942492970
Provider Name (Legal Business Name): HEATHER ELIZABETH LINK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST UNIVERSITY PEDIATRICS; UHC CAMPUS REHAB BLDG
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

1 S PROSPECT ST UNIVERSITY PEDIATRICS; UHC CAMPUS REHAB BLDG
BURLINGTON VT
05401-3456
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4696
  • Fax: 802-847-4612
Mailing address:
  • Phone: 802-847-4696
  • Fax: 802-847-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042.0012570
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number245633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: