Healthcare Provider Details

I. General information

NPI: 1154349512
Provider Name (Legal Business Name): DONALD R. LAUB JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

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: 802-847-7083
Mailing address:
  • Phone: 802-847-0000
  • Fax: 802-847-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number42-0008887
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number42-0008887
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: