Healthcare Provider Details

I. General information

NPI: 1619266624
Provider Name (Legal Business Name): FLETCHER ALLEN HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

PO BOX 1063
BURLINGTON VT
05402-1063
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-0000
  • Fax:
Mailing address:
  • Phone: 802-847-1882
  • Fax: 802-847-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number748
License Number StateVT

VIII. Authorized Official

Name: MR. ROGER DESHAIES
Title or Position: CFO
Credential:
Phone: 802-847-5911