Healthcare Provider Details

I. General information

NPI: 1316296528
Provider Name (Legal Business Name): LUC HILAIRE DUPUIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 EXCHANGE ST
MIDDLEBURY VT
05753-4497
US

IV. Provider business mailing address

1436 EXCHANGE ST
MIDDLEBURY VT
05753-4497
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 Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031146
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: