Healthcare Provider Details

I. General information

NPI: 1790729564
Provider Name (Legal Business Name): BRUCE ALAN CHUTTER-CRESSY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRUCE ALAN CRESSY

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

65 STONE WALL LN
CHARLOTTE VT
05445-9325
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1237
  • Fax:
Mailing address:
  • Phone: 802-425-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055-0030777
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: