Healthcare Provider Details

I. General information

NPI: 1750520185
Provider Name (Legal Business Name): REBECCA L WILCOX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE MC6101
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE MC6101
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-734-4746
  • Fax: 802-847-9644
Mailing address:
  • Phone: 802-734-4746
  • Fax: 802-847-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0420011764
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number042-0011764
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: