Healthcare Provider Details

I. General information

NPI: 1962857227
Provider Name (Legal Business Name): CHARLES ROBERT LITCHFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CENTRE DR
MILTON VT
05468-3104
US

IV. Provider business mailing address

28 CENTRE DR
MILTON VT
05468-3104
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4322
  • Fax: 802-847-1570
Mailing address:
  • Phone: 802-847-4322
  • Fax: 802-847-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number042.0040581
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number309680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: