Healthcare Provider Details

I. General information

NPI: 1558533430
Provider Name (Legal Business Name): EMILY L. A. STEBBINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY LOUISE ANDERSON MD

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 06/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE # WP-2 FLETCHER ALLEN HEALTH CARE, DEPT OF ANESTHESIOLOGY
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE # WP-2 FLETCHER ALLEN HEALTH CARE, DEPT OF ANESTHESIOLOGY
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2717
  • Fax:
Mailing address:
  • Phone: 802-847-2717
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0420012590
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMT201278
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: