Healthcare Provider Details

I. General information

NPI: 1154403996
Provider Name (Legal Business Name): CHAMPLAIN VALLEY ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 EXCHANGE ST
MIDDLEBURY VT
05753-1185
US

IV. Provider business mailing address

1436 EXCHANGE ST
MIDDLEBURY VT
05753-1185
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-3194
  • Fax: 802-388-4881
Mailing address:
  • Phone: 802-388-3194
  • Fax: 802-388-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number0420008791
License Number StateVT

VIII. Authorized Official

Name: DR. BENJAMIN NEAL ROSENBERG
Title or Position: ORTHOPEDICS SURGEON/PRESIDENT
Credential: M.D.
Phone: 802-388-3194