Healthcare Provider Details

I. General information

NPI: 1962454900
Provider Name (Legal Business Name): DAVID J CIESLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE STE 2200
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3790
  • Fax:
Mailing address:
  • Phone: 970-203-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME 100403
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0040580
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number042-0017059
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: