Healthcare Provider Details

I. General information

NPI: 1336404722
Provider Name (Legal Business Name): CHRISTOPHER TYLER VOGT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 RIVERSIDE AVE
BURLINGTON VT
05401-1601
US

IV. Provider business mailing address

617 RIVERSIDE AVE
BURLINGTON VT
05401-1601
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-6309
  • Fax:
Mailing address:
  • Phone: 802-864-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLP02581
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17036
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO 00779
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number032.0133795
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number032.0133795
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: