Healthcare Provider Details

I. General information

NPI: 1447278965
Provider Name (Legal Business Name): FLETCHER ALLEN HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE SMITH 408
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE SMITH 408
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-5066
  • Fax:
Mailing address:
  • Phone: 802-847-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number042-0011183
License Number StateVT

VIII. Authorized Official

Name: IRA BERNSTEIN
Title or Position: FELLOWSHIP DIRECTOR
Credential: M.D.
Phone: 802-847-5066