Healthcare Provider Details

I. General information

NPI: 1962479683
Provider Name (Legal Business Name): ANNE ELIZABETH KLEIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE DERMATOLOGY OUTPATIENT CLINIC, 5TH FLOOR
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE DERMATOLOGY OUTPATIENT CLINIC, 5TH FLOOR
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4570
  • Fax: 802-847-3364
Mailing address:
  • Phone: 802-847-4570
  • Fax: 802-847-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055-0030805
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: