Healthcare Provider Details

I. General information

NPI: 1003479585
Provider Name (Legal Business Name): RICHARD BOHLING CAROZZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

75 CHESTER ST APT 11
ALLSTON MA
02134-2314
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4589
  • Fax:
Mailing address:
  • Phone: 978-501-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number042.0040413
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: