Healthcare Provider Details

I. General information

NPI: 1275514713
Provider Name (Legal Business Name): ROBERT R ALTHOFF MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST FLETCHER ALLEN HEALTH CARE
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

1 S PROSPECT ST FLETCHER ALLEN HEALTH CARE
BURLINGTON VT
05401-3456
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4563
  • Fax: 802-847-7998
Mailing address:
  • Phone: 802-847-4563
  • Fax: 802-847-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042.0011155
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number290106
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number042-0011155
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: